Page 1

HIV/AIDS IN AUSTRIA 2010

17th REPORT OF THE AUSTRIAN HIV COHORT STUDY Austrian Agency for Health and Food Safety www.ages.at


FOREWORD

Alois Stรถger Bundesminister fรผr Gesundheit )HGHUDO0LQLVWHUIRU+HDOWK Vorwort von Bundesminister Alois Stรถger fรผr den Bericht der รถsterreichischen HIV-Kohortenstudie +,9LQยฟ]LHUWHRGHUDQ$LGVHUNUDQNWH0HQVFKHQKDEHQHLQVFKZHUHV6FKLFNVDO]XWUDJHQยฑ]XGHQVFKZHUZLHJHQGHQJHVXQGKHLWOLFKHQ3UREOHPHQNRPPWRIWHLQHJHVHOOVFKDIWOLFKH6WLJPDWLVLHUXQJKLQ]X(VLVWEHGDXHUOLFKGDVV+,9,Qยฟ]LHUWHXQG$,'6.UDQNHLQXQVHUHU*HVHOOVFKDIWQRFKLPPHU9RUXUWHLOHQDXVJHVHW]W VLQG8PVRZLFKWLJHULVWHVGDVVVLFKGLHVH0HQVFKHQDXIGDVHUVWNODVVLJH|VWHUUHLFKLVFKH*HVXQGKHLWVZHVHQ YHUODVVHQN|QQHQ'DVVGHPVRLVWEHZHLVWGHUYRUOLHJHQGH%HULFKWGHU|VWHUUHLFKLVFKHQ+,9.RKRUWHQVWXGLH :DVLQDQGHUHQ/lQGHUQRIW]XHLQHUXQ]XPXWEDUHQยฟQDQ]LHOOHQ%HODVWXQJYRQ3DWLHQWLQQHQXQG3DWLHQWHQ IยKUWยEHUQLPPWLQgVWHUUHLFKGLHVROLGDULVFKH.UDQNHQYHUVLFKHUXQJ7HVWXQJXQG7KHUDSLHVLQGZHLWJHKHQG NRVWHQIUHL1HXHVWHXQGZLUNVDPVWH%HKDQGOXQJVVWUDWHJLHQJDUDQWLHUHQGHQ(UNUDQNWHQHLQZHLWJHKHQG QRUPDOHV/HEHQLQKRKHU4XDOLWlW,QgVWHUUHLFKJLEWHVยฑLP*HJHQVDW]]XDQGHUHQ/lQGHUQยฑNHLQH0HOGHSร€LFKWIยU+,9'DVKDWVLFKQLFKWDOV1DFKWHLOHUZLHVHQ]XPDOXQVHU*HVXQGKHLWVXQG6R]LDOZHVHQIยUHLQH FKURQLVFKHEHKDQGHOEDUH.UDQNKHLWRSWLPDOJHUยVWHWLVW +,9XQG$,'6GยUIHQIUHLOLFKQLFKWEDJDWHOOLVLHUWZHUGHQ'LHVLVWGHPPLWJURย‰HU$NULELHLP9RUIHOGGHU:HOW $LGV.RQIHUHQ]LQ:LHQHUVWHOOWHQ%HULFKW]XHQWQHKPHQLQZHOFKHPGLH$XWRULQQHQXQG$XWRUHQGDV YHUIยJEDUH'DWHQPDWHULDO]XVDPPHQJHIยKUWKDEHQ'HQ$XWRU,QQHQXQGGHQ0LWDUEHLWHU,QQHQGHU|VWHUUHLFKLVFKHQ+,9%HKDQGOXQJV]HQWUHQJHEยKUWGDIยUXQVHUHJDQ]H$QHUNHQQXQJ

Foreword from Federal Minister for Health Alois Stรถger for the Austrian HIV-Cohort Study 7KHIROORZLQJUHSRUWFRQFHUQLQJWKH$XVWULDQ+,9&RKRUW6WXG\SURYHVRQFHPRUHWKDW$XVWULDQVOLYLQJZLWK +,9DQG$,'6FDQUHO\RQWKHLUKHDOWKFDUHV\VWHP8QOLNHWKHKLJKยฟQDQFLDOEXUGHQIRUSDWLHQWVLQRWKHU FRXQWULHVWKH$XVWULDQVRFLDOLQVXUDQFHV\VWHPDFFHSWVWKHLQFXUULQJFRVWVDOPRVWIXOO\7HVWVDQGWKHUDSLHV DUHODUJHO\IUHHRIFRVW7KHODWHVWDQGPRVWHIIHFWLYHWUHDWPHQWVWUDWHJLHVDUHXWLOLVHGWRJXDUDQWHHSDWLHQWV DJRRGTXDOLW\RIOLIH,Q$XVWULDDVRSSRVHGWRRWKHUFRXQWULHV+,9LVQRWDPDQGDWRULO\QRWLยฟDEOHGLVHDVH 7KLVKDVQRWSURYHQWREHDGLVDGYDQWDJHVLQFHRXUKHDOWKDQGZHOIDUHV\VWHPVDUHZHOOHTXLSSHGWRKDQGOH DQ\FKURQLFGLVHDVH 1RQHWKHOHVVWKHVLJQLยฟFDQFHRI+,9DQG$,'6VKRXOGQRWEHPLQLPL]HG,QDQWLFLSDWLRQRIWKH:RUOG$,'6 &RQIHUHQFHLQWKLVLVZKDWLVWREHFRQYH\HGWKURXJKWKLVPHWLFXORXVUHSRUWLQZKLFKWKHDXWKRUVKDYH FRPSLOHGDOOWKHDYDLODEOHGDWD)RUWKLVWKHDXWKRUVDQGWKHFRZRUNHUVRIWKH$XVWULDQ+,9WUHDWPHQWFHQWUHVUHFHLYHRXUGXHUHFRJQLWLRQ


  

 

DEFINITION OF THE COHORT PARTICIPANTS

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DEVELOPMENT OF THE HIV/AIDS EPIDEMIC OVER TIME

   



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ORGANIZATION AND DEVELOPMENT OF THE AUSTRIAN HIV COHORT STUDY







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GLOSSARY AUSTRIAN HIV COHORT STUDY GROUP

 



   

SUMMARY

   



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INTRODUC


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Special challenges for the HIV Patient Management System are:

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HIV Patient Management System: 'HVLJQHGDVDFOLHQWVHUYHUDSSOLFDWLRQWKH+,93DWLHQW0DQDJHPHQW6\VWHPVWRUHVLWVGDWDLQDSHUVLVWHQW 64/GDWDEDVH7KHVRIWZDUHLVEDVHGRQWKHPRGHOGULYHQDUFKLWHFWXUHSDUDGLJPDQGKDVEHHQLPSOHPHQWHG ZLWK0LFURVRIW1(7WHFKQRORJ\7KHFRPSDQ\',+HLQ]$SSR\HU QRZFDOOHGQHWZRUNYLWD ZDVHQWUXVWHGZLWK

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Aims of this cohort study are:    2SWLPL]DWLRQRISDWLHQWPDQDJHPHQW    4XDOLW\PDQDJHPHQW    'RFXPHQWDWLRQRIWKHHSLGHPLRORJ\RIWKH+,9LQIHFWLRQ    )DFLOLWDWLRQRIUHVHDUFKSURMHFWV

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1. INTRODUCTION

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2. ORGANIZATION AND DEVELOPMENT OF THE AUSTRIAN HIV COHORT STUDY


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4. DEFINITION OF THE COHORT PARTICIPANTS

7KH$XVWULDQ+,9&RKRUW6WXG\ $+,9&26 ZLOOEH¿QDQFHGXQWLO6HSWHPEHU VHHDOVRSURMHFWSODQ ± 7KHPDLQWHQDQFHDQGWKHIXWXUHGHYHORSPHQWRIWKH+,93DWLHQW0DQDJHPHQW6\VWHP ³+,3´ DV

3. FINANCING

Vorarlberg

Upper Austria

Linz

&(175(62)7+($8675,$1+,9&2+257678'<


MENT W-UP HORT ANTS


1742

1843

1951

2047

2112

2296*

01.01.2004

01.01.2005

01.01.2006

01.01.2007

01.01.2008

01.01.2009 01.01.2010

1800 2008

1287

1154

1030

897

786

681

AKH Vienna

799 835

745

707

658

621

595

463

Linz

14

Since 1.7.2009 0 3 1 1 2 2 3 1 8 21

Before 1.1.2005 8 268 18 32 172 88 10 11 233 840 Total 8 305 27 45 191 124 22 16 346 1084

4192 4553

5329

5018

4691

4351

4037

3652

Total

Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna Total

102 118

-

-

-

-

-

-

Klagenfurt

Death 1.1.2009 to 1.1.2005 to 30.06.2009 31.12.2008 0 0 3 31 1 7 1 11 1 16 1 33 0 9 0 4 9 96 16 207

409 446

344

305

275

241

209

187

Graz

Total 132 495 197 387 385 419 56 98 1300 3469

870 910

841

805

777

749

705

669

Innsbruck

Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna Total

212 236

-

-

-

-

-

-

Salzburg

Last monitoring with CD4 cell count by residence Missing or Since 1.1.2009 to 1.1.2005 to before 1.7.2009 30.06.2009 31.12.2008 1.1.2005 108 5 12 7 385 14 45 51 160 2 28 7 281 11 48 47 351 6 17 11 302 20 46 51 29 3 5 19 23 5 28 42 776 74 231 219 2415 140 460 454

*Data transfer was too late for incorporating into analyses.

1652

01.01.2003

OWS Vienna

Cumulative number of all cohort participants

6RIDU+,9LQIHFWHGSDWLHQWVSURYLGLQJSHUVRQ\HDUVRIIROORZXSKDYHEHHQUHFUXLWHGLQWRWKH FRKRUWVWXG\:HDVVXPHWKDWWKHUHZHUHPRUHWKDQGHDWKVEXWGDWDHQWU\IURPSDWLHQWVZLWKORVVRI IROORZXSRUODVWFRQWDFWDORQJWLPHDJRLVLQFRPSOHWH0RVWFHQWUHVGRQRWKDYHHQRXJKUHVRXUFHVWRHQWHU GDWDUHWURVSHFWLYHO\

$ORQJVWDQGLQJDLPRIWKH$XVWULDQ+,9FRKRUWVWXG\LVDZLGHYROXQWDU\DQGDQRQ\PRXVFDSWXUHRI+,9 LQIHFWHGSDWLHQWVLQ$XVWULD

5. RECRUITMENT AND FOLLOW-UP OF COHORT PARTICIPANTS

l ro Ty

1.1.2005 to 31.12.2008

Since 1.7.2009

1.1.2009 to 30.06.2009

a a d g ia ng tri tri ur an th si us us in nl zb is l r e A A a M rg Sa C er er w Bu pp Lo U

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1.1.2009 to 30.06.2009

ia yr St

na en Vi

l ro Ty

g er lb r ra Vo 1.1.2005 to 31.12.2008

ia yr St

l ta To

Before 1.1.2005

na en i V

l ta To

Missing or before 1.1.2005

g er lb ar r Vo

Deaths in different periods (deceased cohort participants)

Since 1.7.2009

ia rg ria ria nd ng th st st si la bu is lz rin en Au Au a a M g r r r S C e e w Bu pp Lo U

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Last monitoring with CD4 cell count (living cohort participants)

15


16

3HUVRQVZLWKUHVLGHQF\DEURDGZHUHH[FOXGHGIURPWKLVDQDO\VLV

 5,6.)$&7256)2512)2//2:83,17+(/$670217+6

Univariate regression OR (95% CI) p-value

Frequencies N = 979 / 3371 (29,04%)

<0,001

(32,90%) (25,18%)

555 / 1687 424 / 1684

1,46 1,25 â&#x20AC;&#x201C; 1,69 1

0,009

1,34 1,08 â&#x20AC;&#x201C; 1,68 1

0,010

Model 1 (N= 3371) Multivariate regression* OR (95% CI) p-value

All centres

/ 1161 / 567 / 240 / 1403

1,25 1,05 â&#x20AC;&#x201C; 1,47 1

(30,35%) (25,93%)

720 / 2372 259 / 999

Variable Demographic characteristics $JH <43 years t 43 years *HQGHU Male Female

0,367 0,003 <0,001

0,89 0,70 â&#x20AC;&#x201C;1,14 1,47 1,14 â&#x20AC;&#x201C;1,89 2,32 1,64 â&#x20AC;&#x201C;3,30 1

(27,82%) (33,51%) (44,17%) (25,66%)

323 190 106 360

1,12 0,94 â&#x20AC;&#x201C; 1,33 1,46 1,18 â&#x20AC;&#x201C; 1,80 2,29 1,73 â&#x20AC;&#x201C; 3,04 1

0,218 <0,001 <0,001

<0,001

0,36 0,30 â&#x20AC;&#x201C;0,43 1

(21,97%) (40,31%)

455 / 2071 524 / 1300

0,42 0,36 â&#x20AC;&#x201C; 0,49 1

<0,001

<0,001

2,46 1,88 â&#x20AC;&#x201C;3,21 1

<0,001

(41,71%) (27,23%)

176 / 422 803 / 2949

1,91 1,55 â&#x20AC;&#x201C; 2,36 1

<0,001 0,42 0,34 â&#x20AC;&#x201C; 0,51 1 (16,95%) (32,93%) 139 / 820 840 / 2551

0,164 0,041 0,82 0,62 â&#x20AC;&#x201C; 1,08 0,80 0,64 â&#x20AC;&#x201C;0,99 1 <0,001 <0,001 0,43 0,34 â&#x20AC;&#x201C; 0,55 0,48 0,40 â&#x20AC;&#x201C; 0,58 1 / 93 (100,00%) / 505 (18,02%) / 1017 (19,76%) / 1756 (33,83%) 93 91 201 594

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No &'QDGLU Missing  50 cells/Îźl 50-199 cells/Îźl t 200 cells/Îźl ART $57XVHHYHU

<0,001 0,19 0,15 â&#x20AC;&#x201C;0,23 1 <0,001 0,15 0,13 â&#x20AC;&#x201C;0,18 1 (19,52%) (61,52%) 509 / 2607 470 / 764 Yes No

AKH Vienna 457 495 568 648 690 759 845 961

Linz 240 251 273 290 328 358 383 401

Salzburg 140 167

Innsbruck 368 384 411 429 447 469 483 517

2 1 0 768 0 6 961

Styria Tyrol Vorarlberg Vienna Foreign countries Missing Total

Lower Austria

2

154

Carinthia

Salzburg

2

Burgenland

5

AKH Vienna 21

Upper Austria

ahl

401

0

1

6

0

1

2

2

369

18

2

Linz 0

167

23

10

0

0

2

4

122

6

0

0

Salzburg 0

517

0

12

8

102

349

5

34

3

1

3

Innsbruck 0

HIV-centre

Number of â&#x20AC;&#x153;currentlyâ&#x20AC;? seen patients by residence

* Cohort participants with a CD4 cell count within the previous 6 months ** Data transfer was too late for incorporating into analyses.

01.01.2003 01.01.2004 01.01.2005 01.01.2006 01.01.2007 01.01.2008 01.01.2009 01.01.2010

OWS Vienna 577 617 665 706 769 783 829**

287

1

0

3

0

0

268

0

3

0

5

Graz 7

Graz 129 147 161 188 204 223 263 287

97

1

0

0

0

0

0

0

0

0

96

Klagenfurt 0

Klagenfurt 90 97

Number of â&#x20AC;&#x153;currentlyâ&#x20AC;? seen cohort participants at different points in time*

2430

31

23

785

102

353

281

160

386

173

108

28

Total

Total 1771 1894 2078 2261 2438 2592 2204 2430

06 04 02 04 05 03 03 05 06 07 07 08 08 09 09 10 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 7. 1. 1. 7. 1. 7. 1. 7. 1. 7. 7. 1. 7. 7. 1. 1. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . . . . . . . . . . . . . . . . 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01

3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0

%HFDXVHRIWKHKLJKQXPEHURISDWLHQWVZLWKLQFRPSOHWHIROORZXSPRVWRIWKHDQDO\VHVZHUHGRQHXVLQJ RQO\WKHGDWDRISDWLHQWVZLWK&'FHOOFRXQWZLWKLQWKHSUHYLRXVPRQWKV6XFKDVHOHFWLRQLQĂ&#x20AC;XHQFHVWKH UHVXOWVRIVRPHDQDO\VHV HJULVNIRU+,951$KLJKHUWKDQFRSLHVPO 

 &216758&7,212)$³&855(17&2+257´

Currently seen cohort participants * adjusted for the variables: age

17


EMOGRAPHIC ACTERISTICS THE COHORT ARTICIPANTS


82

112

120

238

122

199

241

63

569

20

18

1685

Lower Austria

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

2430

31

23

785

102

353

281

160

386

173

108

28

Total

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male

20

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male

Female

Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing

Federal state

Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing

Federal state

Female

 *(1'(5$021*+(7(526(;8$//<$&48,5('+,9,1)(&7,21

745

13

3

216

39

38

148

53

31

77

10

18

Female

Carinthia

Male

Gender

Burgenland

nzahl

RIWKHFRKRUWSDUWLFLSDQWVDUHIHPDOH7KHUDWHLVKLJKHVWLQ8SSHU$XVWULD  DQG9RUDUOEHUJ  ,QWKHVXEJURXSRIWKHKHWHURVH[XDOO\LQIHFWHGWKHUDWHRIWKHZRPHQLV,WLVKLJKHVWLQ 9LHQQD  8SSHU$XVWULD  DQG9RUDUOEHUJ  

 *(1'(52)7+(&855(17&2+2573$57,&,3$176

39,3

40,0 40,3

40,8 40,7

41,0 41,1

41,4 41,5

41,8 42,0

42,5 42,5

42,9 43,0

43,4

5 2 3 4 4 3 5 6 7 6 8 7 8 9 0 9 00 00 00 200 200 200 200 200 200 200 200 200 200 200 200 201 . . .2 1.2 7.2 . . . . . . . . . . . 1 7 7 7 7 1 1 1 1 7 7 7 1 1 .0 1.0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 .0 1.0 .0 1.0 1.0 0 01 0 0 01 0 01 0 0 01 0 01 0 0 01 0

36 35

44 43 42 41 40 39 38 37

45

0

10

20

30

40

50

60

70

80

90

0

25

50

75

100

125

150

175

200

0

B

C

10

30

40

50

Age

60

LA

UA

S

St

T

Vo

Current cohort â&#x20AC;&#x201C; all patients

20

Vi

70

90

For. Miss. c.

80

21

7KHDYHUDJHDJHRIWKHSDWLHQWVLV\HDUVDQGLWLVYHU\VLPLODUDFURVVWKHIHGHUDOVWDWHV7KHPHGLDQLV \HDUVRIWKHFRKRUWSDUWLFLSDQWVDUHROGHUWKDQ\HDUVDUHROGHUWKDQ\HDUV

Median age (years)

 $*(2)7+(&855(17&2+2573$57,&,3$176

Number of persons

6. DEMOGRAPHIC CHARACTERISTICS OF THE COHORT PARTICIPANTS

Age (years)


0

10

20

30

40

50

60

Tyrol

Upper Austria

Vienna

Current cohort â&#x20AC;&#x201C; injecting drug use

All modes of transmission

Others

59

80

65

104

106

26

350

14

9

857

Carinthia

Lower Austria

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

22

7

37

Burgenland

MSM

384

3

1

147

28

87

24

6

65

13

6

4

IDU

58

1

0

10

3

7

12

4

10

10

1

0

Blood products

1052

16

6

268

42

141

134

77

209

87

56

16

Heterosexual

Mode of transmission

21

1

0

2

2

5

3

0

7

0

0

1

Vertical

58

1

2

8

1

7

4

8

15

4

8

0

Unknown

2430

31

23

785

102

353

281

160

386

173

108

28

Total

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%HORZWKHDEEUHYLDWLRQ060LVXVHGIRU³0HQZKRKDYHVH[ZLWKPHQ´,'8PHDQV³,QMHFWLQJ'UXJ8VH´7KH FDWHJRU\,'8DOVRLQFOXGHVPHQZKRDUHERWK060DQG,'87KHFDWHJRU\³EORRGSURGXFWV´LQFOXGHVFRKRUW

6.4.1

 02'(2)75$160,66,212)7+(+,9,1)(&7,21

Age (years)

Missing

MSM

ria ria st st Au Au r r e we pp Lo U

ia th

IDU

r bu lz a S

g

Mother-to-child-transmission

C

in ar

ia

r Ty

ol

Blood products

yr St

r ra Vo

g

r Fo

gn ei

na en Vi

Heterosexual

er lb

Mode of transmission (current cohort)

M

g in iss

Vertical

es t ri un o c

Unknown

l ta To

Burgenland Lower Austria Upper Austria Styria Tyrol Vorarlberg Vienna Missing residency Total

Living participants <18 years >18 years 1 1 1 0 5 3 2 3 0 5 4 0 3 2 4 0 20 14

0 0 1 0 4 1 0 0 6

Deceased participants

2 1 9 5 9 5 5 4 40

Total

23

KHUHDUHUHODWHGWRSDWLHQWVZKRKDYHDOVREHHQLQFDUHE\WKHDGXOW+,9WUHDWPHQWFHQWUHV2EYLRXVO\WKHVH GDWDDUHLQFRPSOHWH

1RZDGD\VPRWKHUWRFKLOGWUDQVPLVVLRQLVWKHRQO\URXWHRI+,9WUDQVPLVVLRQDPRQJVWFKLOGUHQ$OO+,9 LQIHFWHGFKLOGUHQLQ$XVWULDDUHIROORZHGLQSDHGLDWULF+,9WUHDWPHQWFHQWUHVWKHUHIRUHWKHGDWDSUHVHQWHG

6.4.2

nd la en g r Bu

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


24

5HFHQWO\DWOHDVWWZRWUDQVPLVVLRQVRIPRWKHUWRFKLOGLQ$XVWULDKDYHEHHQOLQNHGWRFRXQVHOOLQJZLWK+,9 GHQLDOLVWV

,Q-DQXDU\URXWLQH+,9WHVWLQJZDVLQWURGXFHGLQ$XVWULD7KH+,9WHVWLVSDUWRIWKHPRWKHUFKLOGERRNOHW 0XWWHU.LQG3DVV ,QRUGHUWREHHOLJLEOHIRUFKLOGFDUHDOORZDQFH .LQGHUEHWUHXXQJVJHOG \RXPXVWKDYH WKH¿UVWWHQH[DPLQDWLRQVVWLSXODWHGLQWKHPRWKHUFKLOGERRNOHWGRQHFRUUHFWO\DQGREWDLQSURRIRILW

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

d

B

n

C

ch

LA

UA

S

St

T

k g ch Country of birth - all patients

Nationality - Heterosexual

Nationality - IDU

Nationality - MSM

Nationality - all patients

g

Vo

Vi

 1$7,21$/,7<$1'&28175<2)%,57+ /,9,1*3$57,&,3$176

25


26



,QWKHIUDPHZRUNRIVWDWXWRU\KHDOWKLQVXUDQFHDOOJDLQIXOO\DFWLYHSHUVRQVPXVWEHFRPHLQVXUHG$SSUR[LPDWHO\RIWKH$XVWULDQSRSXODWLRQDUHSURWHFWHGE\VWDWXWRU\KHDOWKLQVXUDQFH'HSHQGLQJRQWKHW\SH RIHPSOR\PHQWWKHUHDUHGLIIHUHQWNLQGVRIPDQGDWRU\KHDOWKLQVXUDQFHHJ%9$IRUFLYLOVHUYDQWV69$IRU EXVLQHVVPHQDQGEXVLQHVVZRPHQDQG*..IRUPRVWHPSOR\HHV

 +($/7+,1685$1&(



   



 3529,'(562)+($/7+&$5(



27




STAGE O DISEASE


30

386

160

281

353

102

785

23

31

2430

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

216

316

223

215

224

221

227

178

201

208

248

0%

Bu

n la en rg

0%

30%

40%

50%

60%

70%

80%

90%

727

11

12

266

18

71

113

36

77

58

54

11

A2

A1

A2

rg

A3

bu lz Sa

399

3

3

175

13

41

44

25

28

50

13

4

A3

B1

ia yr St

8

0

0

1

1

1

0

1

3

0

0

1

B1

B2

Ty

l ro

197

2

0

45

7

40

15

8

61

9

7

3

B2

e rlb

B3

ra Vo

rg

254

5

0

69

14

59

22

20

40

16

8

1

B3

C1

en Vi

re Fo

na n ig

4

0

0

0

0

1

0

1

1

1

0

0

C1

C2

un co

tri

es

97

0

1

28

4

16

7

6

29

4

1

1

C2

B Non-AIDS defining conditions B1 B2 B3

Classification according to C DC

A Asymptomatic A1 A2 A3

ria ria st st Au Au r r e pe w Lo Up

144

Total

ia th in

4

Missing

r Ca

0

Foreign countries

d

44

Vienna

100%

10

5% >500

19

Styria 24

9

Salzburg Tyrol

9 15

Lower Austria

8

Carinthia Upper Austria

2

Burgenland

A1

Vorarlberg

hl

10%

2204

2204

489

1099

1093

1346

908

821

1109

690

813

Maximum 738

10%

0

3

8

0

3

0

0

1

0

1

2

Minimum 9

20%

50-199 200-349 350-500

196

205

230

197

175

179

223

145

191

194

258

Median 253

CD4 count 1 Â&#x2022; 500/Îźl 2 200-499/Îźl 3 < 200/Îźl

ng si is

C3

M

600

6

7

157

35

100

61

54

132

26

17

5

C3

ta To

l

2430

31

23

785

102

353

281

160

386

173

108

28

Total

C AIDS C1 C2 C3

31

7KHFODVVLÂżFDWLRQRIWKH+,9LQIHFWLRQDFFRUGLQJWR&'&SXWVSDWLHQWVLQRQHRIWKUHHFOLQLFDOFDWHJRULHV $% & DQGRQHRIWKUHH&'FHOOFRXQWFDWHJRULHV  

 &/$66,),&$7,212)7+(&855(17&2+257$&&25',1*72&'&

15%

20%

25%

30%

35%

40%

45%

<50

173

50%

108

Carinthia

Lower Austria

Mean 265

Current cohort CD4 nadir

Number 28

Burgenland

CD4 nadir (current cohort)

7KHPHGLDQRIWKHORZHVW&'FHOOFRXQWHYHUPHDVXUHG Âł&'QDGLU´ LQWKHFXUUHQWFRKRUWLVÂ&#x2014;O

 /2:(67(9(50($685('&'&(//&2817 &855(17&2+257

7. STAGE OF HIV DISEASE


“ELITENTROLLERS” D “VIREMIANTROLLERS”


%

38

49

CD4 > 500 cells/Îźl and HIV RNA < 400 copies/ml

CD4 > 500 cells/Îźl and HIV RNA < 1000 copies/ml

34

15

CD4 > 500 cells/Îźl and HIV RNA Â&#x201D; 50 copies/ml

3,5%

2,7%

1,1%

243 17,4%

4,9%

CD4 > 500 cells/Îźl

68

HIV RNA < 1000 copies/ml

3,5%

142 10,1%

49

HIV RNA < 400 copies/ml

1,5%

HIV RNA < 5000 copies/ml

21

533 38,1%

N

%

9

8

6

38

20

13

11

8

1,2%

1,1%

0,8%

5,2%

2,7%

1,8%

1,5%

1,1%

75 10,3%

N

N = 728

N = 1400

HIV RNA Â&#x201D; 50 copies/ml

All patients

HIV-infected without ART use

HIV-infected for 6 to 10 years

HIV-infected up to 5 years

11

8

4

23

20

16

13

6

41

N

1,0%

0,7%

0,3%

2,0%

1,7%

1,4%

1,1%

0,5%

3,5%

%

N = 1157

HIV-infected for over 10 years

0HGLDQWLPHIURP+,9LQIHFWLRQWRGHDWKLQXQWUHDWHGSDWLHQWVLVHVWLPDWHGWREHDSSUR[LPDWHO\ \HDUV+RZHYHUWKHUHLVFRQVLGHUDEOHYDULDWLRQLQVXUYLYDOWLPHEHWZHHQSDWLHQWV$VPDOOQXPEHURISDWLHQWV UHPDLQDV\PSWRPDWLFIRUPDQ\\HDUVDQGPDLQWDLQKLJK&'FHOOFRXQWVRUORZSODVPD+,951$OHYHOVRU ERWKZLWKRXWDQWLUHWURYLUDOWKHUDS\3DWLHQWVDEOHWRPDLQWDLQKLJK&'FRXQWVKDYHEHHQFDOOHG³ORQJWHUP QRQSURJUHVVRUV´ZKLOVWWKRVHZLWKORZYLUDOORDGVKDYHEHHQFDOOHG³+,9FRQWUROOHUV´RU³HOLWHFRQWUROOHUV´ 9LUHPLFFRQWUROOHUVKDYHORZEXWUHDGLO\PHDVXUDEOHYLUXVORDGV(OLWHFRQWUROOHUVVXSSUHVV+,9WRH[WUHPHO\ ORZOHYHOVPHDVXUDEOHRQO\E\VHQVLWLYHODERUDWRU\WHFKQLTXHV

8. â&#x20AC;&#x153;ELITE-CONTROLLERSâ&#x20AC;? AND â&#x20AC;&#x153;VIREMIA-CONTROLLERSâ&#x20AC;?

35


4

8

0

15

0

0

21

0

7

65

Lower Austria

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

Active Syphilis: prevalence

8

Carinthia

1969

22

19

593

90

312

222

132

331

138

87

No infection 23

349

2

3

156

12

39

27

26

43

30

8

Status post Syphilis 3

38

2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

MSM 3 3 5 8 25 71 45 52 32 244

Men (not MSM) 0 2 1 3 5 16 8 4 6 45 Women 0 2 1 0 2 6 2 0 2 15 Total 3 7 7 11 32 93 55 56 40 304

7KHIROORZLQJDQDO\VLVLQFOXGHVDOODFWLYHFDVHVRIV\SKLOLVE\\HDURIGLDJQRVLV QHZV\SKLOLVGLDJQRVHV  7KHUHIRUHUHFHQWV\SKLOLVFDVHVDQGLQIHFWLRQVRIXQNQRZQGXUDWLRQDUHLQFOXGHG

9.1.2

Missing 2

Burgenland

9.1.1 Missing values and status post syphilis diagnoses (current cohort)

6\SKLOLVFDQSHUVLVWIRUVHYHUDO\HDUVZKHQLWLVQRWWUHDWHGDQGUHLQIHFWLRQZLWKV\SKLOLVLVSRVVLEOHEHFDXVH WKHUHLVQRSURWHFWLYHLPPXQLW\

 6<3+,/,6

9. CO-INFECTIONS

2003

2004 MSM

2005

2006

2007

Men (not MSM)

New â&#x20AC;&#x153;recentâ&#x20AC;? syphilis infections: incidence

0

20

40

60

80

100

120

2008

2009 Women

0

10

20

30

40

50

60

70

2003

2004 MSM

2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

2005

MSM 1 0 3 2 6 26 27 33 19 117

Women 0 0 0 0 0 2 2 0 1 5

2007 Men (not MSM)

2006

Men (not MSM) 0 1 0 1 0 4 3 0 3 12

2008

Women

2009

Total 1 1 3 3 6 32 32 33 23 134

39

7KLVDQDO\VLVRQO\LQFOXGHVQHZ³UHFHQW´V\SKLOLVLQIHFWLRQVGH¿QHGDVIROORZVSDWLHQWVZLWKDIRUPHUV\SKLOLV UHVXOWWKDWZDVHLWKHUQHJDWLYHRUDVWDWXVSRVWWUHDWPHQWDQGZKRQRZSUHVHQWHGZLWKDFWLYHV\SKLOLV QHZ ³UHFHQW´V\SKLOLVLQIHFWLRQV 

9.1.3

Cases per 1000 person-years Cases per 1000 person-years


15

769

5

10

1645

Vorarlberg

Vienna

Foreign countries

Missing

Total

652

19

16

14

73

252

22

118

127

6

5

119

1

2

1

14

67

2

8

24

0

0

Latent infection 0

14

1

0

1

0

1

1

1

6

2

1

Tuberculosis 0

2430

31

23

785

102

353

281

160

386

173

108

28

Total

550

1

1

10

1

0

64

1

5

91

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

40

67

5

Lower Austria

1834

23

22

248

231

144

290

144

92

2

Carinthia

23

No infection

1

Missing

Burgenland

zahl

ZHUHFODVVL¿HGDV+&9QHJDWLYH

110

1

0

49

4

22

12

5

6

8

2

1

Ab positive, HCV RNA neg. (spontaneous)

Hepatitis C

34

0

0

2

4

10

4

2

9

2

1

0

Ab positive, HCV RNA neg. (therapy)

361

2

0

120

27

72

24

8

80

14

11

3

Chronic HCV

2430

31

23

785

102

353

281

160

386

173

108

28

Total

+&9FRLQIHFWLRQZDVGH¿QHGE\DSRVLWLYHUHVXOWRQDTXDOLWDWLYHRUTXDQWLWDWLYH51$WHVWUHVXOW:HDVVXPHG WKDWSDWLHQWVZLWKDSRVLWLYH+&9DQWLERG\WHVWEXWZLWKRXWDQDYDLODEOH+&951$WHVWZHUHDOVRFRLQIHFWHG ZLWK+&9+RZHYHUSDWLHQWVZLWKDSRVLWLYH+&9DQWLERG\WHVWDQGDQHJDWLYHUHVXOWRQDQ+&951$WHVW

 +(3$7,7,6& &855(17&2+257

33

Tyrol

Upper Austria

33

229

Lower Austria

256

165

Carinthia

Styria

102

Burgenland

Salzburg

Missing 28

No infection 0

18 2 1 12 1 0 125 1 5 183

Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing Total

661

13

2

186

20

46

106

30

142

60

48

No infection 8

37

1

3

1

1

8

0

16

5

2

0

954

9

8

310

34

141

124

53

173

55

37

Antibody positive 10

Hepatitis B No antibodies despite vaccination 0

517

3

9

132

44

146

26

57

54

32

9

Antibody positive (vaccination) 5

78

0

0

31

3

11

13

3

10

6

1

Chronic HBV 0

2430

31

23

785

102

353

281

160

386

173

108

28

Total

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1.7.2004

1.7.2006 Lamivudin only Tenofovir + Lamivudin ART without HBV-medication

1.7.2005

1.7.2008

1.7.2009 Tenofovir only Tenofovir + Emtricitabin Neither ART nor HBV-therapy

1.7.2007

157,EDFNERQHVLQF$57FRPELQDWLRQVIRU+%9+,9FRLQIHFWHGSDWLHQWV0RVWRIWKH+%9+,9FRLQIHFWHG SDWLHQWV  LQFDUHDWRQHRIWKH$XVWULDQ+,9WUHDWPHQWFHQWUHVUHFHLYHGDQ157,EDFNERQHWRKHOS FRQWUROWKH+%9LQIHFWLRQ

Therapy for hepatitis B &XUUHQWJXLGHOLQHVUHFRPPHQGWKHXVHRIWHQRIRYLUDQGHPWULFLWDELQHRUWHQRIRYLUDQGODPLYXGLQHDVWKH

13

Burgenland

Missing 5

Carinthia

nzahl

&KURQLF+%9ZDVGH¿QHGE\DSRVLWLYHUHVXOWRQDKHSDWLWLV%VXUIDFHDQWLJHQ +%V$J WHVWRUE\DSRVLWLYH +%9'1$WHVWUHVXOW

7XEHUFXORVLVLVLQFRPSOHWHO\UHFRUGHGLQWKH+,93DWLHQW0DQDJHPHQW6\VWHP

Tuberculosis

 +(3$7,7,6% &855(17&2+257

 78%(5&8/26,6 &855(17&2+257

41


42

$JH \HDUV r VG

)HGHUDOVWDWH Upper Austria Styria Tyrol Others/missing/foreign countries Vienna *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero &RLQIHFWLRQZLWK+%9+&9 $,'6 &'QDGLU FHOOVÂ&#x2014;O r VG

&XUUHQW&' FHOOVÂ&#x2014;O r VG

/DVW+,951$ log10 copies/ml (± s.d.) <400 copies/ml d50 copies/ml 6WDJHRIGLVHDVH Liver cirrhosis Current renal insufficiency (stage 3, 4, 5) Last bilirubin (mg/dl ± s.d.) Last PT (% ± s.d.) Last patelet count (G/l ± s.d.) +,9WKHUDS\ Currently on therapy +HSDWLWLVWKHUDS\ Currently on therapy Previous treatment

87,2%

88,5%

69 -

18 65

319 4,9% 18,3%

88,4%

37 10,2% 21 5,8% 0,9 r 2,1 93 r 14,3 195 r 80,4

4 5,1% 5 6,4% 1,1 r 2,8 94 r 14,1 204 r 70,9

68

1,9 r 1,1 301 83,4% 270 74,8%

63,2% 36,8%

2,2 r 1,3 57 73,1% 53 67,9%

228 133

22,2% 6,6% 19,9% 18,0% 33,2%

21 5,8% 255 70,6% 29 8,0% 56 15,5% 13 3,6% 158 43,8% 168 r 150,8 501 r 307,4

74,4% 25,6%

58 20

80 24 72 65 120

26 33,3% 23 29,5% 9 11,5% 20 25,6% 13 16,7% 29 37,2% 181 r 158,1 414 r 246,6

12,8% 16,7% 14,1% 16,7% 39,7%

n= 361 43,1 r 9,4

n= 78 39,0 r 9,7

10 13 11 13 31

Chronic hepatitis C

Chronic hepatitis B

ZKRKDYHEHHQFOHDUHGIURP+&9KDYHUHFHLYHGDQWL+&9WKHUDS\7KHSDWLHQWVZLWKDVXVWDLQHGYLURORJLFDOUHVSRQVHDUHDFFRPSDQLHGE\SDWLHQWVZKRIDLOHGYLURORJLFDOO\WKXVUHYHDOLQJDVXFFHVVUDWHRI SDWLHQWVZLWKRQJRLQJWUHDWPHQWZHUHQRWDVVHVVHG 6LQFHKHSDWLWLV&LVWUHDWHGLQVRPHUHJLRQVRXWVLGH +,9WUHDWPHQWFHQWUHVWKHVHGDWDDUHWRDFHUWDLQH[WHQWLQFRPSOHWH

2YHUDOOWUHDWPHQWUDWHVUHPDLQORZIRUSDWLHQWVFRLQIHFWHGZLWKKHSDWLWLV&YLUXV +&9 DQG+,9,QWKH$XVWULDQ+,9FRKRUWVWXG\DWOHDVW  RIWKHSDWLHQWVZLWKFKURQLFKHSDWLWLV&DQGWKHSDWLHQWV

 &+521,&+(3$7,7,6%$1'&+521,&+(3$7,7,6&

43


DEV OF EPID OVE


46

303

209

145

133

106

135

121

154

156

135

137

169

182

167

169

158

172

224

204

208

224

252

234

261

195

4553

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Total

N

1985

 +,9

Number of positive HIV tests

Male

Female

85 987 989 991 993 995 997 999 001 003 005 007 009 19 1 1 1 1 1 1 1 2 2 2 2 2

0

50

100

150

200

Gender

85 987 989 991 993 995 997 999 001 003 005 007 009 19 1 1 1 1 1 1 1 2 2 2 2 2

0

50

100

150

200

250

300

Total

10. DEVELOPMENT OF THE HIV/AIDS EPIDEMIC OVER TIME

Number of positive HIV tests

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

0

10

30

40

50

60

Age at time of the first positive test

Median age at time of the HIV test

20

Age

70

80

90

47


Styria

Lower Austria

Upper Austria

Vienna

Missing

Tyrol

Burgenland Salzburg Foreign countries

Carinthia Vorarlberg

8 5 8 7 89 91 9 3 9 5 9 7 9 9 0 1 03 05 0 7 0 9 19 19 19 19 19 19 19 19 20 20 20 20 20

85 87 8 9 91 93 95 9 7 9 9 01 03 0 5 07 09 19 19 19 19 19 19 19 19 20 20 20 20 20

10

20

Federal state

0

Federal state

0

20

40

60

80

100

120

48

N u m b e r o f p o s i ti v e H I V te s ts

65,1%

Lithuania Germany Austria Hungary Romania Slovakia Bosnia and Herzegovina Croatia Serbia Poland Russian Federation Albania Italy Ukraine Turkey Thailand India Viet Nam Armenia Georgia Egypt Liberia Congo Eritrea Cameroon Democratic Rep. of Congo Ghana Kenya Nigeria Uganda Zambia Algeria Guinea-Bissau Mozambique USA Dominican Republic Brazil Chile Missing

1 10 143 2 2 2 2 2 3 2 8 1 4 1 1 7 1 2 1 2 1 1 1 1 4 1 1 3 14 1 1 1 1 1 1 2 1 1 0

Germany Austria Bulgaria Hungary Romania Slovakia Bosnia and Herzegovina Croatia Poland Russian Federation Italy Belgium England Netherlands Portugal Slovenia France Turkey Thailand Myanmar Armenia Georgia Africa Egypt Gambia Congo Somalia Cameroon Gabon Ghana Guinea Kenya Nigeria Uganda Sierra Leone Mozambique America USA Missing

15 170 1 2 6 1 2 2 1 10 3 1 1 1 1 1 1 2 3 1 1 2 1 1 1 2 1 2 1 1 1 5 9 2 1 1 1 2 1

N=261

8,8%

Positive HIV test 2008

61,1%

6,9%

5,0%

11,1% 1,5% 1,5%

N=234

2,6%

Positive HIV test 2007

6,0%

7,7%

5,1%

4,3%

13,2%

Austria Eastern and Southeastern Europe Asia Others/missing 1,0%

N=195 Germany Austria Hungary Romania Czech Republic Bosnia and Herzegovina Croatia Serbia Poland Russian Federation Greece Italy England Portugal Slovenia Ukraine Turkey Afghanistan Pakistan Thailand Indonesia and Timor Georgia Africa Tanzania Zimbabwe Cameroon Ghana Burkina Faso Kenya Nigeria Guinea-Bissau Dominican Republic Missing

5 132 2 3 1 2 2 2 1 2 1 2 1 1 1 1 2 1 1 2 1 1 1 1 1 2 1 2 5 12 1 1 1

49

67,7%

Positive HIV test 2009

4,6%

8,7%

2,6% 2,1%

13,3%

Western Europe CIS-states Africa

10.1.1 Nationality: HIV diagnoses between 2007 and 2009


50

Source: EuroHIV + addition from AHIVCOS

l d nd en m nd UK urg any nce ece an tria and ark ga la ed lgiu ela o m ra re rl us nl m rtu e b e A Fi en o Ic Sw Be Ir m er F G itz P D xe G w u S L

70% 60% 50% 40% 30% 20% 10% 0%

Percentage of persons originating from high prevalence countries (prevalence at adults > 1%) among heterosexually infected persons newly diagnosed with HIV in 2006 in different European countries.

/RZSUHYDOHQFHFRXQWULHVDUHFRXQWULHVZLWKDQ+,9LQIHFWLRQUDWHRIDGXOWVKLJKSUHYDOHQFHFRXQWULHV DUHFRXQWULHVZLWKDQ+,9LQIHFWLRQUDWHRIDGXOWVÂ&#x2022;

10.1.2 Nationality of the heterosexually infected

10.1.3 Categories of heterosexual infection

51


52

Number of the positive HIV-tests

Number of the positive HIV-tests

19

0

5

10

15

Sex with an IDU

Sex with a hemophilac

87 989 991 993 995 997 999 001 003 005 007 009 2 2 2 2 2 1 1 1 1 1 1

Sex with a MSM

19

Sub-categories of heterosexual contacts

Missing Originating from a high prevalence country Sex with a MSM Sex with an IDU Sex with a hemophilac Sex with person originating from a high prevalence country Sex wit HIV+ person not matching in the categories above Believes to be infected heterosexually

Sub-categories of heterosexual contacts

85 987 989 991 993 995 997 999 001 003 005 007 009 1 2 1 2 2 1 2 1 2 1 1 1

85

19

50 45 40 35 30 25 20 15 10 5 0

53

6XEW\SHVZHUHGHWHUPLQHGE\JHQRW\SLFUHVLVWDQFHWHVWLQJRI5HYHUVH7UDQVFULSWDVH 57 DQG3URWHDVHDFFRUGLQJWR6WDQIRUGGDWDEDVH([DPSOHVRIWKHXVHRIWKHUHVLVWDQFHWHVWLQ7\URODQG8SSHU$XVWULDDUHJLYHQLQ WKHJUDSKVEHORZ

10.1.4 HIV-1 subtypes


54

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

A

B

World

World

World

C

D

Austria

Austria

Austria

Upper Austria

Upper Austria

F, G, H, J, K

Tyrol

CRFAE

Styria

Styria

Styria

Other recombinants

Salzburg

Salzburg

Salzburg

CRFAG

Upper Austria

Not heterosexual

Tyrol

Heterosexual

Tyrol

All patients

Is the HIV test used ef ciently

1,0

153 2000

0,7 0,4 0,5 0,5

250 226 251 182

2006 2007

0,6

2008 2009

2005

0,6

204 2004

218

0,7 0,7

218 202

2002 2003

0,8

0,7

167 1999

170

0,6

166

2001

1,1

179

3,6 2,7

132 165

1995 1996 1998

3,6

129 1994

1997

7,2 3,5

136 147

1992 1993

9,0 4,1

121

98 116

>12 >12

120

1988 1989 1990

>12

130

1991

>12

186

1986 1987

>12

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(0,

(1,

(0,

(3,

(7,

1,

1,

2,

4) 2)

9)

2, >12) 3, >12)

5, >12) 4, >12) 3, >12)

>12, >12) 8, >12)

7, >12) 10, >12)

>12, >12) >12, >12) >12, >12)

>12, >12) >12, >12)

>12, >12) >12, >12)

>12, >12) >12, >12) >12, >12)

>12, >12) >12, >12)

(all >12)

All patients Months

259

N

17

21

37

33

32

34

30

40

30

33

23

17

34

20

21

17

44

34

32

34

38

52

69

124

170

N

0,9

0,9

1,5

2,9

4,7

2,7

2,2

1,1

5,2

1,9

6,5

0,5

3,7

7,5

3,7

5,5

0,9

7,8

2,4

0,5

10,7

>12

>12

>12

>12

9,

12,

(0,

(0,

(0,

3,

5,

6,

(1, >12,

(0, >12,

(1,

(0, >12,

(0, >12,

(1, >12,

(1, >12,

(0, >12,

(0, >12,

(0, >12,

(0, >12,

(0, >12,

(0, >12,

(0, >12,

(1, >12,

(0, >12,

(0,

(0, >12,

(0, >12,

(2, >12,

(8, >12,

6)

10)

12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

>12)

(all >12)

IDU Months

Time between HIV test and first CD4 cell count measurement in months (median, percentiles 25, 75, 90)

1985

Year of HIV test

352

357

314

371

340

330

341

373

352

342

282

353

289

333

293

343

325

308

350

310

302

315

300

402

330

Median

(188 - 520)

(227 - 516)

(151 - 521)

(199 - 570)

(130 - 523)

(153 - 508)

(174 - 499)

(189 - 622)

(149 - 570)

(173 - 522)

(100 - 476)

(143 - 530)

(137 - 507)

(180 - 513)

(110 - 510)

(162 - 555)

(93 - 539)

(136 - 525)

(129 - 593)

(96 - 563)

(107 - 577)

(141 - 521)

(132 - 607)

(193 - 613)

(176 - 560)

Quartiles

First CD4 cell count (all patients, 228 missing)

55

$XVWULDKDVRQHRIWKHKLJKHVWUDWHVRI+,9WHVWVLQ(XURSH VHHJUDSK 1HYHUWKHOHVVDVXEVWDQWLDOSRUWLRQRI WKHSDWLHQWV  DUHGLDJQRVHGODWHDQGKDYHDGYDQFHGLPPXQHGHÂżFLHQF\ &'FHOOFRXQWÂ&#x2014;O DW WKHWLPHRIWKHLUÂżUVWFRQWDFWZLWKDQ+,9FHQWUH

10.1.


56

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

2

4

6

8

10

12

14

16

<50

200-349

350-500

>500

2001

2002

2003

2004

2005

2006

2007

2008

2009

N.a./1.CD4-measurement >6 months after HIV test

Diagnosis AIDS within 3 months of testing HIV positive

50-199

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

CD4 count at first presentation

6HHDOVRKRPHSDJHRIWKH*HUPDQ$XVWULDQ6ZLVV$,'6&RQJUHVV 6g'$.  KWWSDEVWUDFWVVRHGDNFRPFRQWHQWOLVWSKS

10.1.6 “Early” and “late” diagnoses

Percent of patients

0

25

50

75

0

50

100

150

200

All patients

Advanced diagnosis

Intermediate diagnosis

2007 2008 2009

Intermediate diagnosis

2004 2005 2006

Advanced diagnosis Early diagnosis

2001 2002 2003

IDU

Advanced diagnosis Early diagnosis

2001 2002 2003 2004 2005 2006 2007 2008 2009

0

25

50

75

0

25

50

75

2003 2004

Advanced diagnosis Early diagnosis

2001 2002

Intermediate diagnosis

2008 2009

57

Intermediate diagnosis

2005 2006 2007

Hetero

Advanced diagnosis Early diagnosis

2005 2006 2007 2008 2009

MSM

Early diagnosis

2001 2002 2003 2004

Intermediate diagnosis

2001 2002 2003 2004 2005 2006 2007 2008 2009

All patients

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%


58

690 282 110 892

764

(11,97%) (23,77%) (17,38%) (3,64%) (11,55%)

(43,48%) (45,04%) (48,18%) (55,94%)

Univariate regression OR (95% CI) p-value

1,31 1,03 – 1,67 1 1,59 1,19 – 2,14

0,028

Model 1 (N = 1974) Multivariate regression* OR (95% CI) p-value

1,52 1,17 –1,96 1

0,001

0,002

1 2,39 1,82 – 3,13 1,61 1,11 – 2,33 0,29 0,10 – 0,80 1 0,31 1,51 1,23 1,01 3,14 1,53 0,12 0,77 1

0,11 1,04 0,72 0,67 2,14 1,04 0,02 0,30

– – – – – – – –

0,87 2,21 2,10 1,52 4,59 2,24 0,85 1,98

1,36 1,05 – 1,75 1 0,28 0,17 – 0,44 1

<0,001 0,012 0,017

1,85 1,33 –2,58 1,44 0,97 –2,15 0,23 0,08 –0,65 1

<0,001 0,073 0,005

0,027 0,031 0,448 0,950 <0,001 0,030 0,034 0,582

0,018

<0,001

0,003

0,42 0,24 – 0,75 1

0,012 -

1,65 1,12 – 2,44 -

Univariate regression p-value OR (95% CI)

0,62 0,52 – 0,74 1 0,88 0,72 – 1,07

<0,001

1,69 1,30 –2,21 1 0,30 0,18 –0,49 1

<0,001

<0,001

Model 1 (N = 1974) Multivariate regression* p-value OR (95% CI)

0,58 0,48 –0,70 1

<0,001

0,201

1 0,61 0,50 – 0,74 0,65 0,49 – 0,84 0,73 0,49 – 1,09 1 0,86 1,27 1,62 1,32 1,09 1,25 1,10 0,67 1

0,54 0,95 1,09 1,00 0,78 0,93 0,64 0,36

– 1,35 – 1,69 – 2,40 – 1,75 – 1,52 – 1,68 1,90 – 1,24

1,21 1,01 – 1,45

<0,001 0,001 0,124

0,66 0,52 –0,84 0,77 0,58 –1,03 0,74 0,49 –1,11 1

<0,001 0,080 0,142

0,500 0,107 0,018 0,054 0,625 0,132 0,735 0,199

0,043

1 <0,001

1,48 1,14 –1,91 1

0,003

³/DWH´GLDJQRVLVLVGH¿QHGDV&'FHOOFRXQWEHORZDWWLPHRI+,9GLDJQRVLVDQGRU$,'6ZLWKLQ PRQWKVRI+,9GLDJQRVLV

987 987

543

/ / / /

164 49 4 103

84 247 116 259 168 235 55 46 764

987 987

690 282 110 892

(51,93%)

/ / / /

300 127 53 499

84 247 116 259 168 235 55 46 764

(46,73%)

357 /

1,53 1,21 – 1,93 1

0,902 0,091 0,014

³(DUO\´GLDJQRVLVRU³UHFHQW´LQIHFWLRQLVGH¿QHGDVDFXWH+,9LQIHFWLRQ ZHVWHUQEORWSDWWHUQRUDQWLJHQ+,9 51$FRPELQHGZLWKFOLQLFDOSUHVHQWDWLRQ RUGRFXPHQWHGVHURFRQYHUVLRQZLWKQHJDWLYH+,9WHVWQRWPRUH WKDQ\HDUVEHIRUHWKH¿UVWSRVLWLYHWHVW

(18,03%) (14,39%)

178 / 142 /

65 /

(4,76%) (19,43%) (16,38%) (13,90%) (33,33%) (19,57%) (1,82%) (10,87%) (13,74%)

/ / / / / / / / /

4 48 19 36 56 46 1 5 105

(5,88%) (18,49%)

21 / 357 299 / 1617

(43,57%) (55,62%)

430 / 549 /

543

(42,86%) (52,63%) (58,62%) (53,67%) (48,81%) (52,34%) (49,09%) (36,96%) (46,73%)

/ / / / / / / / /

36 130 68 139 82 123 27 17 357

(58,26%) (47,68%)

208 / 357 771 / 1617

0,98 0,75 – 1,29 0,32 0,09 – 1,20 1,50 1,08 – 2,07 1

10.1.6.2 Risk factors for a “late” diagnosis (HIV diagnosis 2001-2009)

Frequencies N= 320 / 1974 (16,21%)

(17,82%)

255 / 1431

(17,77%) (13,74%)

215 / 1210 105 / 764

(19,72%) (0,00%) (5,88%) (12,94%)

/ 1349 / 13 / 357 / 255

266 0 21 33

Frequencies N= 979 / 1974 (49,59%)

(48,71%)

697 / 1431 282 /

(51,40%)

622 / 1210

(47,81%) (23,08%) (58,26%) (48,24%)

/ 1349 / 13 / 357 / 255

645 3 208 123

10.1.6.1 Risk factors for an “early” diagnosis (HIV diagnosis 2001-2009)

All centres Variable Demographic characteristics $JH < 38 years t38 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDOVWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\KLJKDQGORZSUHYDOHQFHFRXQWULHV High prevalence countries Low prevalence countries 1DWLRQDOLW\ Austria Missing High prevalence countries Low prevalence countries * adjusted for the variable: gender

All centres Variable Demographic characteristics $JH < 38 years t38 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDOVWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\KLJKDQGORZSUHYDOHQFHFRXQWULHV High prevalence countries Low prevalence countries 1DWLRQDOLW\ Austria Missing High prevalence countries Low prevalence countries 59

* adjusted for the variables: gender, area of residence


60

0,72 0,50 â&#x20AC;&#x201C;1,05 1 0,78 0,44 â&#x20AC;&#x201C;1,37 1

(4,90%) (6,82%) (3,93%) (6,02%)

59 / 1203 52 / 763 14 / 356 97 / 1610

61 / 575 (10,61%) 50 / 1391 (3,59%)

0

1

3

4

5

Patients still alive: Early: 264 203 Intermediate: 818 641 Advanced: 443 369

166 511 300

123 376 235

86 290 183

0,0

0,0

Years after HIV diagnosis

0,1

0,1 2

0,2

0,2

0,4 0,3

0,5 0,4 0,3

0,6

0,7

0,8

0,5 p<0,001

Advanced diagnosis

0,9

1,0

1

2

3

323 143 470 41

MSM

<0,001

0,027 <0,001 0,006

236 109 362 27

4

171 90 278 20

5

Others/ missing

Hetero IDU

2,61 1,78 â&#x20AC;&#x201C;3,81 1

0,50 0,27 â&#x20AC;&#x201C;0,93 2,84 1,75 â&#x20AC;&#x201C;4,63 2,52 1,31 â&#x20AC;&#x201C;4,84 1

Model 1 (N = 1966) Multivariate regression* p-value HR (95% CI)

Years after HIV diagnosis

p<0,001

<0,001

0,382

0,084

0,043 <0,001 <0,001

0,194

0,227

Patients still alive: MSM: 534 406 IDU: 223 185 Hetero: 703 572 Others: 65 50

0

Survival after the HIV test Early + intermediate diagnosis

0,6

0,7

0,8

0,9

1,0

2,78 1,91 â&#x20AC;&#x201C;4,04 1

0,56 0,32 â&#x20AC;&#x201C;0,98 2,85 1,85 â&#x20AC;&#x201C;4,39 3,02 1,59 â&#x20AC;&#x201C;5,72 1

688 (2,47%) 281 (13,88%) 105 (11,43%) 892 (4,82%)

/ / / /

1,34 0,86 â&#x20AC;&#x201C;2,08 1

(5,97%) (4,80%)

85 / 1424 26 / 542 17 39 12 43

0,79 0,54 â&#x20AC;&#x201C;1,16 1

(4,37%) (6,92%)

Univariate regression p-value HR (95% CI)

43 / 983 68 / 983

* adjusted for the variables: age, gender, area of residence, nationality

Stage of disease $GYDQFHGGLDJQRVLV Yes No

Variable Demographic characteristics $JH < 38 years t38 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\KLJKDQGORZSUHYDOHQFHFRXQWULHV High prevalence countries Low prevalence countries

Frequencies N = 111 / 1966 (5,65%)

'DWHRIFHQVRULQJODVWFRQWDFWZLWKWKH+,9FHQWUH PLVVLQJ

³$GYDQFHG´GLDJQRVLVLVGH¿QHGDV&'FHOOFRXQWEHORZDWWLPHRI+,9GLDJQRVLVDQGRU$,'6ZLWKLQ PRQWKVRI+,9GLDJQRVLV All centres

10.1.6.4 Risk factors for mortality after the HIV diagnosis (2001-2009)

987 987

Model 1 (N = 1974) Multivariate regression* p-value OR (95% CI)

All centres

<0,001

0,51 0,41 â&#x20AC;&#x201C;0,63 1

<0,001

(22,59%) (35,66%)

0,53 0,43 â&#x20AC;&#x201C; 0,64 1

0,518

223 / 352 /

1

(30,20%)

543

(21,01%) (26,24%) (37,27%) (35,31%)

690 282 110 892

Univariate regression p-value OR (95% CI)

Frequencies N= 575 / 1974 (29,13%)

Variable

84 247 116 259 168 235 55 46 764

0,93 0,75 â&#x20AC;&#x201C; 1,16

(28,72%)

411 / 1431

Demographic characteristics $JH < 38 years t38 years *HQGHU Male

383 1 123 68

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDOVWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\KLJKDQGORZSUHYDOHQFHFRXQWULHV High prevalence countries Low prevalence countries 1DWLRQDOLW\ Austria Missing High prevalence countries Low prevalence countries

164 /

Female

<0,001 0,088 0,978

0,47 0,36 â&#x20AC;&#x201C;0,62 0,76 0,55 â&#x20AC;&#x201C;1,04 1,01 0,66 â&#x20AC;&#x201C;1,54 1

<0,001 0,005 0,686

/ / / /

145 74 41 315

0,49 0,39 â&#x20AC;&#x201C; 0,61 0,65 0,48 â&#x20AC;&#x201C; 0,88 1,09 0,72 â&#x20AC;&#x201C; 1,64 1

0,815 0,024 0,002 0,981 0,157 0,086 0,636 0,989

â&#x20AC;&#x201C; 1,58 â&#x20AC;&#x201C; 1,94 â&#x20AC;&#x201C; 2,88 â&#x20AC;&#x201C; 1,38 â&#x20AC;&#x201C; 1,87 â&#x20AC;&#x201C; 1,82 2,12 â&#x20AC;&#x201C; 1,96

0,56 1,05 1,28 0,73 0,90 0,96 0,63 0,51

(25,00%) (33,60%) (40,52%) (26,25%) (31,55%) (31,91%) (29,09%) (26,09%) (26,18%)

/ / / / / / / / /

21 83 47 68 53 75 16 12 200

0,94 1,43 1,92 1,00 1,30 1,32 1,16 1,00 1

0,022 (30,99%) (26,18%) 375 / 1210 200 / 764

1,27 1,03 â&#x20AC;&#x201C; 1,55 1

0,015 (34,45%) (27,95%) 123 / 357 452 / 1617

1,35 1,06 â&#x20AC;&#x201C; 1,73 1 (28,39%) (7,69%) (34,45%) (26,67%) / 1349 / 13 / 357 / 255

1,09 0,81 â&#x20AC;&#x201C; 1,47 0,23 0,03 â&#x20AC;&#x201C; 1,80 1,45 1,02 â&#x20AC;&#x201C; 2,06 1

0,574 0,161 0,041

10.1.6.3 Risk factors for an â&#x20AC;&#x153;advancedâ&#x20AC;? diagnosis (HIV diagnosis 2001-2009)

* adjusted for the variable: gender, area of residence and nationality - "high and low prevalence countries"

61


62

301

939

929 311

13 /

47 /

40 / 20 /

452 297

193 298

12 / 8 /

16 / 24 /

175 311 306 448

/ / / /

11 17 12 20

0,60 0,34 0,43

1

(6,22%) (2,68%) (3,54%)

(8,08%)

1

0,84 1

(4,32%) (5,01%)

(4,31%) (6,43%)

0,86

1,12 1,33 0,95 1

0,86 1

(4,23%) (4,97%)

9 / 213 51 / 1027

(6,29%) (5,47%) (3,92%) (4,46%)

0,57 1

(3,60%) (6,72%)

749 491

27 / 33 /

1,79 1,26 1,13 1

(5,61%) (5,43%) (4,44%) (3,96%)

481 184 45 530

/ / / /

27 10 2 21

1,58 1

(5,24%) (3,79%)

897 343

47 / 13 /

0,93 1

621 619

27 / 33 /

(4,35%) (5,33%)

0,49 â&#x20AC;&#x201C; 1,44

0,47 â&#x20AC;&#x201C;1,59

0,30 â&#x20AC;&#x201C;1,20 0,15 â&#x20AC;&#x201C;0,76 0,23 â&#x20AC;&#x201C;0,82

0,53 â&#x20AC;&#x201C;2,33 0,70 â&#x20AC;&#x201C;2,54 0,46 â&#x20AC;&#x201C;1,94

0,42 â&#x20AC;&#x201C;1,75

0,34 â&#x20AC;&#x201C;0,95

1,01 â&#x20AC;&#x201C;3,17 0,59 â&#x20AC;&#x201C;2,68 0,27 â&#x20AC;&#x201C;4,83

0,85 â&#x20AC;&#x201C;2,92

0,56 â&#x20AC;&#x201C;1,55

0,524

0,633

0,010

0,146 0,009

0,770 0,386 0,880

0,680

0,030

0,046 0,543 0,866

0,145

0,789

Univariate regress ion HR (95% CI) p-value

0,42 1

0,58 0,35

0,54 1

0,10 â&#x20AC;&#x201C; 3,49 0,15 â&#x20AC;&#x201C; 0,81 0,22 â&#x20AC;&#x201C; 0,80

0,32 â&#x20AC;&#x201C; 0,92

0,008

0,551 0,014

0,024

Model 1 (N = 1240) Multivariate regression* HR (95% CI) p-value

0

2

3

4

Patients without AIDS: Non-metropolitan: 659 543 Metropolitan: 451 379

455 325

361 250

279 179

0

1

2

3

174 281 171

134 216 140

4

100 166 107

5

HIV RNA >= 100 000

HIV RNA < 10 000

Years after HIV diagnosis

p=0,004

Patients without AIDS: <10 000: 262 205 Up to 99999: 402 338 Â&#x2022;100 000: 259 208

0,0

0,0

Years after HIV diagnosis

0,1

0,1

5

0,2

0,2

1

0,3

0,3

0,4

0,5

0,5

p=0,028

0,6

0,6

0,4

0,7

0,7

0,9

1,0

0,8

Metropolitan

Non-metropolitan

0,8

0,9

1,0

Time until AIDS (early + intermediate diagnoses only)

* adjusted f or the variables: age, gender, mode of transmission, nationality, first CD4 cell count, early diagnosis, HIV test until f irst contact

Health behavior (DUO\GLDJQRVLV Yes No (interm ediate diagnos is) +,9WHVWXQWLOILUVWFRQWDFW P RQWKV  <3,5 m onths (3. quartile) Â&#x2022;3,5 m onths (3. quartile)

10 000 - 99 999 copies/m l Â&#x2022;100 000 copies /m l

Stage of disease )LUVW&'FHOOFRXQW 1. CD4 cell count >6 m . after HIV test 200-349 350-499 Â&#x2022;500 )LUVW+,951$ Missing or >6 m . after HIV test <10 000 copies/m l

Variable Demographic characteristics $JH <36 years t36 years *HQGHU Male Fem ale 0RGHRIWUDQVP LVVLRQ MSM IDU Others/m is sing Hetero $UHDRIUHVLGHQFH Non-m etropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries

Frequencies N = 60 / 1240 (4,84%)

374 71 92 81 86 88 91 79 55 54 63 55 59 64 82 72 47 1513

AIDS <6 months Reported AIDS after HIV test cases AHIVCOS BMG 35,0% 1219 21,1% 172 31,5% 209 33,3% 142 37,2% 104 38,6% 99 44,0% 102 31,6% 88 43,6% 93 35,2% 97 44,4% 52 49,1% 71 50,8% 59 42,2% 64 46,3% 72 47,2% 70 55,3% 48 38,7% 2761 291 81 67 55 36 51 41 44 45 41 44 44 57 47 53 50 37 1084

All deaths AHIVCOS

198 52 46 37 21 31 22 26 30 22 25 24 33 25 33 19 19 663

AIDS-related deaths AHIVCOS

975 116 97 45 43 33 29 36 35 19 14 9 17 11 12 9 6 1506

AIDS-related deaths BMG

Missing/ abroad Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Total

65 19 22 66 425 83 97 248 84 404 1513

AIDS cases AHIVCOS

AIDS <6 months Reported AIDS cases after HIV test AHIVCOS BMG 44,6% 36,8% 32 63,6% 72 53,0% 173 32,5% 463 67,5% 120 60,8% 184 33,1% 274 47,6% 122 31,2% 1321 38,7% 2761

38 13 8 42 305 27 45 191 69 346 1084

All deaths AHIVCOS

29 9 4 19 243 15 20 128 41 155 663

AIDS-related deaths AHIVCOS

16 42 72 249 58 117 145 65 742 1506

AIDS-related deaths BMG

AIDS-Statistics: HIV Cohort Study vs. cases reported to Ministry of Health (BMG)

Before 1994 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

AIDS cases AHIVCOS

AIDS-Statistics: HIV Cohort Study vs. cases reported to Ministry of Health (BMG)

63

%HFDXVHPRVWRIWKH$,'6FDVHVKDYHRFFXUUHGEHIRUHWKHXVHRIWKH+,93DWLHQW0DQDJHPHQW6\VWHPDQG PDQ\RIWKHVHSDWLHQWVKDYHGLHGWKHGRFXPHQWDWLRQRISDWLHQWVZLWK$,'6LVLQFRPSOHWH H[FHSWLRQV7\URO DQG8SSHU$XVWULD 

3DWLHQWVZLWKPLVVLQJ&'FHOOFRXQWVRUGDWHRIÂżUVWFRQWDFWKDYHEHHQH[FOXGHGIURPWKHVHFDOFXODWLRQV

All centres

 $,'6

10.1.6.5 Risk factors for developing AIDS (early + intermediate diagnoses)


64

0

200

400

600

800

1000

1200

2002

2002

2001

2001

2000

2000

0

2003

2003

50

2004

2004

100

2005

2005

150

2006

2006

Estonia Latvia Lithuania

0

10

20

30

40

50

60

70

80

0

10

20

30

40

50

2000

2000

200

2001

2001

60

2002

2002

70

2003

2003

250

Portugal UK Lux Belgium France Ireland Nether Austria Greece 2004

2004

300

2005

2005

New HIV diagnoses 2000-2006 per million inhabitants

Undiagnosed HIV infections (estimate) (33.3% of all known HIV infections) Total

Patients without ART not in AHIVCOS (40% of the HIV infected without ART in AHIVCOS)

Patients without ART in AHIVCOS

Patients on ART not in AHIVCOS (33.3% of all treated)

Patients on ART in AHIVCOS (66.6% of all treated)

Malta Cyprus Poland Slovenia Bulgaria Czech R Romania Hungary Slovakia

Norway Denmark Sweden Finland Iceland Germany

6560

1639

540

1350

1011

2021

$ERXWWZRWKLUGVRIWKHSDWLHQWVRQDQWLUHWURYLUDOWUHDWPHQW $57 LQ$XVWULDDUHUHJLVWHUHGLQWKHFRKRUW VWXG\3HUVRQVZLWKUHVLGHQFHLQIRUHLJQFRXQWULHVKDYHEHHQH[FOXGHGIURPWKLVDQDO\VLV

 +2:0$1<+,9,1)(&7,216$5(7+(5(,1$8675,$"

2006

2006

65

Source: ECDC


66

Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: ECDC

Total 313 339 428 402 442 423 470 453 442 515 505 507

BMG

Total 313 339 428 402 442 423 470 453 442 515 505 507

BMG

AHIVCOS

Drug Heterosexually users infected 17 (10,2%) 79 (47,3%) 23 (13,6%) 85 (50,3%) 33 (20,9%) 66 (41,8%) 30 (17,4%) 81 (47,1%) 42 (18,8%) 109 (48,7%) 31 (15,2%) 98 (48,0%) 34 (16,3%) 107 (51,4%) 33 (14,7%) 108 (48,2%) 33 (13,1%) 105 (41,7%) 37 (15,8%) 93 (39,7%) 24 (9,2%) 107 (41,0%) 18 (9,2%) 84 (43,1%) Others 12 (7,2%) 15 (8,9%) 12 (7,6%) 15 (8,7%) 14 (6,3%) 11 (5,4%) 8 (3,8%) 13 (5,8%) 12 (4,8%) 13 (5,6%) 12 (4,6%) 12 (6,2%)

Austria 137 82,0% 127 75,1% 124 78,5% 129 75,0% 175 78,1% 140 68,6% 147 70,7% 150 67,0% 163 64,7% 143 61,1% 170 65,1% 132 67,7%

Low prevalence countries 16 9,6% 23 13,6% 14 8,9% 13 7,6% 26 11,6% 22 10,8% 18 8,7% 21 9,4% 40 15,9% 40 17,1% 46 17,6% 29 14,9%

AHIVCOS High prevalence countries 13 7,8% 18 10,7% 19 12,0% 27 15,7% 21 9,4% 41 20,1% 43 20,7% 48 21,4% 49 19,4% 51 21,8% 44 16,9% 33 16,9%

Total 167 169 158 172 224 204 208 224 252 234 261 195

Missing 1 0,6% 1 0,6% 1 0,6% 3 1,7% 2 0,9% 1 0,5% 0 0,0% 5 2,2% 0 0,0% 0 0,0% 1 0,4% 1 0,5%

New HIV diagnoses in the AHIVCOS by nationality

Homosexual men 59 (35,3%) 46 (27,2%) 47 (29,7%) 46 (26,7%) 59 (26,3%) 64 (31,4%) 59 (28,4%) 70 (31,3%) 102 (40,5%) 91 (38,9%) 118 (45,2%) 81 (41,5%)

Total 167 169 158 172 224 204 208 224 252 234 261 195

Women 36 (21,6%) 61 (36,1%) 45 (28,5%) 48 (27,9%) 66 (29,5%) 63 (30,9%) 71 (34,1%) 62 (27,7%) 64 (25,4%) 58 (24,8%) 66 (25,3%) 45 (23,1%)

New HIV diagnoses in the AHIVCOS by mode of transmission and gender

New HIV diagnoses in the EU according to risks

10.4.1

172 224 204 208 224 252 234 261 195 1974

2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

Year of HIV test

Number of HIV diagnoses

933

35 57 84 107 115 135 130 132 138

Available resistance tests before ART

65

2 3 5 7 8 12 7 7 14

Any resistance

Number of patients with resistance test before HIV therapy

The following codons and amino acids were classified as resistance (WHO):

VXUYHLOODQFHRIWUDQVPLWWHG+,9GUXJUHVLVWDQFHXSGDWH3/R62QH  H

67

Basics: 7KHUDWHRIWUDQVPLVVLRQRIGUXJUHVLVWDQW+,9 ³SHUFHQWZLWKUHVLVWDQFH´ FRUUHVSRQGVWRWKHQXPEHURISDWLHQWVZLWKUHVLVWDQFHPXWDWLRQVLQUHODWLRQWRWKHQXPEHURISDWLHQWVZLWKDJHQRW\SLFUHVLVWDQFHWHVW)RUWKLV WKHJHQRPHVRIWKHUHYHUVHWUDQVFULSWDVH 57 DQGWKHSURWHDVH 3 ZHUHVHTXHQFHG*HQRW\SLFUHVLVWDQFH WHVWVZHUHPRVWO\GRQHDWWKH,QVWLWXWHRI9LURORJ\DWWKH0HGLFDO8QLYHUVLW\9LHQQD7KHUHVLVWDQFHPXWDWLRQV KDYHEHHQFODVVL¿HGDFFRUGLQJWR%HQQHWW'(&DPDFKR5-2WHOHD'HWDO'UXJUHVLVWDQFHPXWDWLRQVIRU

)RUWKLVDQDO\VLVRQO\UHVLVWDQFHWHVWVZKLFKKDYHEHHQSHUIRUPHGEHIRUHWKHEHJLQQLQJRIDQWLUHWURYLUDO WKHUDS\ZHUHXVHG3DWLHQWVZHUHHLWKHUDQDO\VHGDFFRUGLQJWRWKHWLPHRIWKHLQIHFWLRQLIWKLVZDVNQRZQRU HVWLPDWHG ³UHFHQWLQIHFWLRQ´ RULIWKLVZDVQRWNQRZQSDWLHQWVZHUHDQDO\VHGDFFRUGLQJWRWKH\HDURIWKH +,9GLDJQRVLV

 75$160,66,212)'58*5(6,67$17+,9


â&#x20AC;&#x17E;Recentâ&#x20AC;? infection (time of infection known or estimated)

68

175 52 6 110

343

Total

37 27 39 46 51 34 53 42 14

MSM IDU Others/missing Hetero

Mode of transmission

2001 2002 2003 2004 2005 2006 2007 2008 2009

Year of "recent" HIV infection

Number of "recent" HIV infections

206

112 26 4 64

17 12 23 32 31 24 29 28 10

Available resistance tests before ART

Â&#x2021; 0LGSRLQWEHWZHHQODVWQHJDWLYHDQGÂżUVWSRVLWLYH+,9WHVW

Â&#x2021; 7LPHSRLQWRIWKHDFXWH+,9LQIHFWLRQRU

&DOFXODWLRQRIWKHWLPHRILQIHFWLRQ \HDURIWKH+,9LQIHFWLRQ 

14

7 2 5

2 1 2 2 3 3 1

Any resistance

Â&#x2021; 'RFXPHQWHGVHURFRQYHUVLRQZLWKDQHJDWLYH+,9WHVWQRWPRUHWKDQ\HDUVEHIRUHWKHÂżUVWSRVLWLYH    WHVW

Â&#x2021; $FXWH+,9LQIHFWLRQ ZHVWHUQEORWSDWWHUQRUDQWLJHQ+,951$ZLWKFOLQLFDOV\PSWRPV

³5HFHQW´LQIHFWLRQPHDQV

)RUWKHDQDO\VLVRIWUDQVPLVVLRQRIGUXJUHVLVWDQW+,9RQO\UHVLVWDQFHWHVWVZKLFKKDYHEHHQSHUIRUPHGEHIRUH DQWLUHWURYLUDOWKHUDS\ZDVVWDUWHGZHUHXVHG3DWLHQWVZHUHHLWKHUDQDO\VHGDFFRUGLQJWRWKHWLPHRIWKHLQIHFWLRQLIWKLVZDVNQRZQRUHVWLPDWHG ³UHFHQWLQIHFWLRQ´ RULIWKLVZDVQRWNQRZQSDWLHQWVZHUHDQDO\VHG DFFRUGLQJWRWKH\HDURIWKH+,9GLDJQRVLV

10.4.2 3-classresistance NNRTI and PI NRTI and NNRTI Resistance to NRTI and PI PI

NNRTI NRTI Any resistance Wild type Attempted Number of resistance Available HIV tests resistance infections before ART tests

1 1 1 1 1 1 1 3 2 1 1 2 1 2 1 1 1 2 1 2 2 3 3 1 15 12 22 30 29 24 26 25 9 17 12 23 32 31 24 29 28 10 18 12 25 32 31 25 32 30 10 37 27 39 46 51 34 53 42 14 2001 2002 2003 2004 2005 2006 2007 2008 2009

1 1 1 2 1 6 1 1 1 2 2 3 3 2 8 1 44 21 50 74 3 47 21 52 82 4 47 22 55 87 4 52 42 146 94 9 Central South East West Missing

1 1 1 1 1 5 1 2 2 2 2 1 2 7 2 5 105 24 4 59 112 26 4 64 118 28 4 65 175 52 6 110 MSM IDU Others/missing Hetero

1 1 1 2 7 1 4 4 1 12 2 153 39 165 41 174 41 272 71 Male Female

1 1 1 2

1 1 1 2 8 4 5

2 6 1 3 2 3 5 9 99 93 104 102

14 192 206 215 69

171 172

109 106

343 Total < 36 years Â&#x2022; 36 years

Age at time of HIV-test Gender

Mode of transmission Residence

Year of HIV infection 5HFHQWLQIHFWLRQV

Transmission of drug resistant HIV according to the time of the "recent" HIV infection, residence, mode of transmission, gender and age


70

514 226 103 777

1620

Total

143 191 168 162 182 211 195 205 163

MSM IDU Others/missing Hetero

Mode of transmission

2001 2002 2003 2004 2005 2006 2007 2008 2009

Number of HIV diagnoses

722

245 72 35 370

22 44 65 77 90 105 103 100 116

Available resistance tests before ART

Unknown time of infection (not “recent”)

Year of HIV test

10.4.3

51

27 2 4 18

3 4 7 7 9 7 3 11

Any resistance

Transmission of drug resistant HIV according to the time of the HIV diagnosis, residence, mode of transmission, gender and age 1RWUHFHQWLQIHFWLRQV Attempted Number of resistance Available HIV tests resistance diagnoses before ART tests

Wild type

Any resistance

NRTI

NNRTI

Resistance to NRTI and PI PI

NRTI and NNRTI

NNRTI and PI

3-classresistance

Year of HIV diagnsis 2001 2002 2003 2004 2005 2006 2007 2008 2009

143 191 168 162 182 211 195 205 163

22 46 69 77 97 112 112 102 122

22 44 65 77 90 105 103 100 116

22 41 61 70 83 96 96 97 105

3 4 7 7 9 7 3 11

1 2 2 4 4 3 1 4

2 1 2 2 2 1 1

1 3 2 3 4 1 6

1 -

-

-

-

Residence Central South East West Missing

192 301 794 241 92

142 125 294 159 39

135 119 282 150 36

126 113 259 140 33

9 6 23 10 3

2 2 12 4 1

1 1 5 3 1

6 3 7 3 1

1 -

-

-

-

Mode of transmission MSM IDU Others/missing Hetero

514 226 103 777

249 78 36 396

245 72 35 370

218 70 31 352

27 2 4 18

9 2 2 8

9 2

10 2 8

1 -

-

-

-

Gender Male Female

1150 470

535 224

516 206

474 197

42 9

17 4

9 2

17 3

1 -

-

-

-

Age at time of HIV-test

1620

Total

809 811

< 34 years • 34 years

344 415 759

325 397 722

302 369 671

23 28 51

10 11

6 5

21

8 12

11

20

1 1

-

-

0

-

0

0

71


ANTIRETROVI THERAPY (AR


74

VLHQW$57GXULQJDIWHUWKHDFXWH+,9LQIHFWLRQHWF 

2Q-DQXDU\SDWLHQWV  ZHUHRQDQWLUHWURYLUDOWKHUDS\LQWKH+,9WUHDWPHQWFHQWUHV2I WKHSDWLHQWVQRWRQWUHDWPHQWRQ-DQXDU\KDGUHFHLYHGDQWLUHWURYLUDOWUHDWPHQWDWDQHDUOLHU SRLQWLQWLPH ZRPHQZKRZHUHRQ$57WRSUHYHQWPRWKHUWRFKLOGWUDQVPLVVLRQSDWLHQWVZKRUHFHLYHGWUDQ-

(9,76%) (18,32%)

157 / 1608 175 / 955 53 / 312 279 / 2251

(16,99%) (12,39%)

(12,98%) (16,52%) (20,47%) (10,26%)

840 460 171 1092

109 76 35 112

/ / / /

(13,17%) (12,43%)

(15,46%) (10,45%)

237 / 1799 95 / 764

198 / 1281 134 / 1282

1,79 1,23 â&#x20AC;&#x201C;2,58 1

0,49 0,39 â&#x20AC;&#x201C;0,63 1

0,48 0,38 â&#x20AC;&#x201C;0,61 1 1,45 1,05 â&#x20AC;&#x201C;1,99 1

1,40 0,99 â&#x20AC;&#x201C;2,00 1,85 1,32 â&#x20AC;&#x201C;2,60 2,81 1,79 â&#x20AC;&#x201C;4,42 1

1,43 1,12 â&#x20AC;&#x201C;1,83 1

1,30 0,99 â&#x20AC;&#x201C;1,73 1,73 1,26 â&#x20AC;&#x201C;2,37 2,25 1,48 â&#x20AC;&#x201C;3,43 1

1,07 0,83 â&#x20AC;&#x201C;1,38 1

1,57 1,24 â&#x20AC;&#x201C;1,98 1

Model 1 (N= 2563) Frequencies N= Univariate regression Multivariate regression* OR (95% CI) 332 / 2563 (12,95%) OR (95% CI)

(5,16%) (11,91%) (9,29%) (7,37%)

55 / 1065 71 / 596 17 / 183 109 / 1478

/ / / /

(7,67%) (7,38%) (6,10%) (10,98%) (16,92%) (5,19%)

30 38 22 36

90 / 1173 36 / 488

(6,88%) (8,29%)

492 346 130 693

* adjusted for the variables: age, gender

Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries

57 / 829 69 / 832

Frequencies N= 126 / 1661 (7,59%)

0,37 0,25 â&#x20AC;&#x201C;0,54 1 2,03 1,10 â&#x20AC;&#x201C;3,75 1

1,29 0,75 â&#x20AC;&#x201C;2,20 1

1,15 0,64 â&#x20AC;&#x201C; 2,07 2,36 1,41 â&#x20AC;&#x201C;3,94 4,57 2,46 â&#x20AC;&#x201C;8,48 1

75

Model 1 (N= 1661) Multivariate regression* OR (95% CI)

0,40 0,28 â&#x20AC;&#x201C;0,58 1

1,19 0,72 â&#x20AC;&#x201C;1,95 2,25 1,40 â&#x20AC;&#x201C;3,62 3,72 2,11 â&#x20AC;&#x201C;6,56 1

1,04 0,70 â&#x20AC;&#x201C;1,56 1

0,82 0,57 â&#x20AC;&#x201C;1,18 1

Univariate regression OR (95% CI)

Risk not to receive ART despite a CD4 nadir <200 and/or AIDS

Variable Demographic characteristics $JH <45 years t 45 years *HQGHU

All centres

11.2.2

* adjusted for the variable: gender

High prevalence countries Low prevalence countries

Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\

Variable Demographic characteristics $JH <44 years t 44 years *HQGHU

All centres

11.2.1

 180%(52)3$7,(17621$17,5(7529,5$/7+(5$3< Risk not to receive ART despite a CD4 nadir <350 and/or AIDS

 $&&(6672$17,5(7529,5$/7+(5$3<

11. ANTIRETROVIRAL THERAPY (ART)


0,19 (0,15 –0,23) 1

0,82 (0,62 –1,08) 0,80 (0,64 –0,99) 1

1,79 (1,23 –2,58) 1 Not applicable

2,46 (1,88 –3,21) 1

76

(0,40 –0,75)

Not applicable

0,49 (0,39 –0,63) 0,55 1 1

0,36 (0,30 –0,43) 1

(0,53 –1,24) (1,25 –2,84) (0,41 –1,91)

OR (95% CI)***

1,40 (0,99 –2,00) 0,81 1,85 (1,32 –2,60) 1,89 2,81 (1,79 –4,42) 0,88 1 1

1,43 (1,12 –1,83) 1

OR (95% CI)**

Risk factors for Risk factors for starting ART not receiving ART with a CD4 <200 despite a more than 6 months CD4 nadir <350 after the HIV and/or AIDS diagnosis

0,89 (0,70 –1,14) 1,47 (1,14 –1,89) 2,32 (1,64 –3,30) 1

1,34 (1,08 –1,68) 1

OR (95% CI)*

*** adjusted for the variables: age, gender and nationality

** adjusted for the variables: gender

* adjusted for the variables: age

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan area Metropolitan city 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease &'QDGLU Missing  50 cells/μl 50-199 cells/μl t 200 cells/μl ART $57XVHHYHU Yes No

Variable Demographic characteristics $JH <43/44/43 years t 43/44/43 years *HQGHU Male Female

Risk factors for no follow-up in the last 6 months

Summary of indicators of access to ART and health care

All centres

11.2.3

Use of therapy regimens over time

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

No

th

3 NRTI 1+ NNRTI & 1+ PI No ART use

2+ NRTI & 1+ PI (All) 3 classes

er ap y

2+

NR TI &

NR 1+ PI

2+

TI &

RT I

TI NN

NR 1+

3

(A ll) 3

cla

ss es

PI (M on

o)

1+

NN

RT I&

2

TI & 1+ PI

NR

Therapy regimens on January 1, 2010

Other HIV therapies PI (Mono) 1+ PI & 1+ InI

1+

I

PI & In

1+

1+

In

I

O th

er s

2+ NRTI & 1+ NNRTI 2 NRTI & 1+ InI

12 06 12 06 12 06 12 06 06 06 12 12 06 12 12 06 12 11717171177117717/0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 1 2 3 3 2 4 4 5 6 5 6 7 8 7 8 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SDWLHQWVKDYHFXUUHQWO\3, 0RQR 

 5(*,0(162)7+($17,5(7529,5$/7+(5$3<

77


78

d an nl e g ur B

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total

Miss.

For. c.

Vi

Vo

T

St

S

UA

LA

C

B

Other HIV therapies PI (Mono) 1+ PI & 1+ InI

g ur zb al S

1,0%

20

,0%

0

,0%

0

,5%

3

,0%

0

1,0%

3

,8%

2

2,1%

3

2,1%

7

,0%

0

2,3%

2

,0%

0

ria ty S

ng si is M

5,6%

115

,0%

0

,0%

0

5,9%

38

5,9%

5

9,3%

27

3,8%

9

5,0%

7

6,3%

21

5,3%

8

,0%

0

,0%

0

Others

l ta To

100,0%

2039

100,0%

17

100,0%

18

100,0%

649

100,0%

85

100,0%

290

100,0%

240

100,0%

141

100,0%

336

100,0%

151

100,0%

88

100,0%

24

Total

2+ NRTI & 1+ NNRTI 2 NRTI & 1+ InI

,8%

16

,0%

0

,0%

0

,5%

3

2,4%

2

1,4%

4

,8%

2

,7%

1

,9%

3

,7%

1

,0%

0

,0%

0

1+ PI & 1+ InI

a es tri nn ie un V o c gn ei r Fo

1,6%

32

,0%

0

,0%

0

1,5%

10

,0%

0

1,0%

3

,0%

0

,7%

1

3,9%

13

2,6%

4

1,1%

1

,0%

0

2 NRTI & 1+ InI

2+ NRTI & 1+ PI (All) 3 classes

g er lb ar r o V

,2%

5

,0%

0

,0%

0

,2%

1

,0%

0

,0%

0

1,3%

3

,0%

0

,0%

0

,0%

0

1,1%

1

,0%

0

1+ NNRTI & 1+PI

l ro Ty

1,7%

34

,0%

0

,0%

0

3,9%

25

,0%

0

,0%

0

,0%

0

,0%

0

,9%

3

3,3%

5

,0%

0

4,2%

1

PI (Mono)

Therapy regimen

(All) 3 classes

3 NRTI 1+ NNRTI & 1+ PI No ART use

,6%

13

,0%

0

,0%

0

,8%

5

,0%

0

,0%

0

,0%

0

,0%

0

2,1%

7

,7%

1

,0%

0

,0%

0

3 NRTI

a a ia tri tri th us us in A A ar C er er w pp Lo U

856

42,0%

948

23,5%

76,5%

46,5%

4

77,8%

22,2%

13

14

4

276

42,5%

288

25,9%

65,9%

44,4%

22

28,3%

59,0%

56

82

47,1%

46,3%

171

113

44,0%

47,5%

111

62

41,7%

42,3%

67

140

49,7%

37,7%

142

75

60,2%

35,2%

57

53

62,5%

33,3%

31

15

2+ NRTI & 1+ NNRTI

8

2+ NRTI & 1+PI

Therapy regimens in the current cohort

385

Zidovudin

134

0

76

202

69

0

01.01.02

357

288

01.01.02

330

7

52

294

7

131

12

158

01.01.05

307

416

01.01.05

433

595

255

412

7

52

350

5

163

22

208

01.01.06

312

437

01.01.06

431

782

119

1312

174

117

488

01.01.06

Maraviroc

Enfuvirtide

Entry-/ fusion inhibitors

0

01.01.02

16

01.01.05

18

01.01.06

11.4.4 Use of entry-/ fusion inhibitors y

Ritonavir as booster

Tipranavir

Saquinavir

Lopinavir/r

Indinavir

Fosamprenavir

Darunavir 600 mg

Darunavir 400 mg

Darunavir

Atazanavir

PI

11.4.3 Use of PI

Nevirapin

Etravirin

Efavirenz

NNRTI

11.4.2 Use of NNRTI

15

567

Tenofovir

Stavudin

35 1238

931

224

412

01.01.05

Lamivudin

310

277

01.01.02

Use of NRTI

Emtricitabin

Didanosin

Abacavir

NRTI

11.4.1

20

01.01.07

492

3

59

501

2

147

44

286

01.01.07

297

4

471

01.01.07

353

962

42

1286

420

72

581

01.01.07

 $'0,1,67(5('$17,5(7529,5$/'58*6

3

20

86

1255

4

871

1061

11

631

224

22

530

01.07.08

228

23

544

01.01.09

270

33

616

01.01.10

383

3

15

537

1

88

67

245

01.07.08

430

2

16

528

1

89

67

292

01.01.09

611

2

10

441

1

101

80

134

214

339

01.01.10

9

9

01.07.08

10

4

01.01.09

21

3

01.01.10

79

Number of patients treated with the drug 01.01.08

562

3

66

650

1

154

80

313

121

1009

15

944

747

23

637

01.01.10

Number of patients treated with the drug 01.01.08

295

22

500

141

898

17

1020

606

23

671

01.01.09

Number of patients treated with the drug 01.01.08

294

1058

23

1341

577

54

702

01.07.08

Number of patients treated with the drug 01.01.08


126

55

412

400

30

563

268

01.01.07

01.01.07

106

39

569

557

22

512

233

47

g

87

Tenofovir + Didanosin

93

162

78

67

70

410

34

410

331

01.01.05

33

83

43

83

69

407

172

511

409

01.01.06

18

23

27

45

57

324

417

476

533

01.01.07

112

83

22

492

567

13

326

106

01.07.08

13

11

23

37

41

273

571

431

195

72

17

549

548

12

287

92

01.01.09

80

3HUFHQWDJHZLWKFXUUHQW+,951$ t FRSLHVPO

NRTI-, NNRTI- and PI-drugs ever received

318

53

14

740

564

11

233

60

01.01.10

7

9

7

24

24

131

604

256

646

01.07.08

8

9

8

22

19

112

745

223

613

01.01.09

57 

40

803



(39,4%)

(N= 2430) (34,1%)

(N = 2039)

Current cohort

829

Current cohort and current ART

5

3

2

17

16

76

1060

165

613

01.01.10

Number of patients treated with the drug

01.01.08 663

128

01.01.10

11.4.8 Number of patients who have ever received NRTI-, NNRTI- and PI-drugs

232

Stavudin + Lamivudin

82

Abacavir + Zidovudin

60

407

Zidovudin + Lamivudin

86

2

Tenofovir + Emtricitabin

Didanosin + Lamivudin

321

Tenofovir + Lamivudin

Tenofovir + Abacavir

289

01.01.04

Abacavir + Lamivudin

NRTI

59

01.01.09

Number of patients treated with the drug

01.01.08

9

01.07.08

Number of patients treated with the drug

01.01.08

0RVWO\DFRPELQDWLRQRI157,LVXVHGKRZHYHUDWOHDVWSDWLHQWVUHFHLYHÂ&#x2022;157,

11.4.7 Use of NRTI combinations

"Atripla"

251

65

66

"Ziagen"

346

40

237

"Trizivir"

29

143

27

738

337

"Truvada"

59

"Retrovir"

832

340

01.01.06

172

605

"Epivir"

01.01.05

"Kivexa"

286

"Combivir"

01.01.02

11.4.6 Use of commercial preparations

Raltegravir

01.01.06

% 93,8 24,0

2003 2004 2005 2006 2007 2008 2009

% of patients with ART interruptions 8,7% 4,6% 7,2% 5,3% 3,9% 4,1% 2,6%

2003

2004

2005

2006

2007

2008

2009

0,00

0,02

0,04

0,06

0,08

0,10

0,12

0,14

2003

2004

2005

2006

2007

2008

2009

Number of ART interruptions in the respective year

0,00

0,05

0,10

0,15

0,20

0,25

0,30

0,35

0,40

0,45

0,50

Number of ART switches in the respective year

% of patients with ART switches 28,7% 27,4% 27,3% 31,3% 23,8% 25,4% 23,4%

Percentage of patients with ART switches and interruptions

N=1061 (the rapy starte d be fore 1.1.2004) Pers ons with treatm ent s witc hes since 2003 Pers ons with treatm ent interruptions since 2003

7KHFDOFXODWLRQVLQFOXGHDOOSDWLHQWVLQWKHFXUUHQWFRKRUWZKRKDYHLQLWLDWHGWKHUDS\EHIRUH

01.01.05

Integrase inhibitor

01.01.02

 $576:,7&+(6$1',17(55837,2163(5&$/(1'$5<($5

11.4.5 Use of integrase inhibitors

Mean treatment changes per patient Mean treatment interruptions per patient

81


(25,00%) (23,98%)

(24,16%) (23,94%)

15 / 60 240 / 1001

108 / 447 147 / 614

64 / 260 100 / 458 91 / 343

&'QDGLU <50 cells/Îźl 50-199 cells/Îźl t200 cells/Îźl

0,90 0,62 â&#x20AC;&#x201C;1,31 0,77 0,56 â&#x20AC;&#x201C;1,07 1

82

1RULVNIDFWRUVZHUHLGHQWLÂżHG

0,594 0,123

0,934

1,01 0,76 â&#x20AC;&#x201C;1,35 1

-

0,857

1,61 0,63 0,40 0,53 0,89 0,55 -

1,06 0,58 â&#x20AC;&#x201C;1,93 1

3,15 0,97 0,74 0,91 1,35 0,89 1

<0,001 0,892 0,320 0,718 0,155 0,626 3,60 0,91 0,87 0,88 1,16 0,87 1

1,81 0,57 0,47 0,51 0,75 0,53 â&#x20AC;&#x201C;7,17 â&#x20AC;&#x201C;1,44 â&#x20AC;&#x201C;1,64 â&#x20AC;&#x201C;1,54 â&#x20AC;&#x201C;1,81 â&#x20AC;&#x201C;1,45 -

0,359 1,05 0,68 â&#x20AC;&#x201C;1,63 <0,001 2,10 1,39 â&#x20AC;&#x201C;3,16 0,624 0,95 0,51 â&#x20AC;&#x201C;1,77 1

0,002 0,69 0,48 â&#x20AC;&#x201C; 0,983 1

â&#x20AC;&#x201C;6,16 â&#x20AC;&#x201C;1,49 â&#x20AC;&#x201C;1,35 â&#x20AC;&#x201C;1,55 â&#x20AC;&#x201C;2,05 â&#x20AC;&#x201C;1,44

0,85 0,60 â&#x20AC;&#x201C;1,20 1,95 1,35 â&#x20AC;&#x201C;2,82 0,87 0,49 â&#x20AC;&#x201C;1,54 1

11.5.2 Risk factors for treatment switches since 2003

* adjusted for the variables: nationality, AIDS, duration of therapy

(24,62%) (21,83%) (26,53%)

(48,78%) (22,68%) (18,18%) (21,50%) (29,03%) (21,13%) (0,00%) (0,00%) (23,21%)

/ / / / / / / / /

20 44 16 23 54 30 0 0 68

(19,94%) (36,36%) (20,24%) (22,66%)

41 194 88 107 186 142 0 10 293

/ 331 / 187 / 84 / 459

66 68 17 104

0,64 0,48 â&#x20AC;&#x201C;0,85 1

(21,16%) (29,69%)

149 / 704 106 / 357

<0,001 0,675 0,673 0,666 0,508 0,599 -

0,823 <0,001 0,881

0,040

<0,001

1,63 1,22 â&#x20AC;&#x201C;2,17 1

(28,44%) (19,62%)

151 / 531 104 / 530 <0,001 1,72 1,27 â&#x20AC;&#x201C;2,33 1

Model 1 (N = 1061) Univariate regression Multivariate regression* OR (95% CI) p-value OR (95% CI) p-value

Frequencies N= 255 / 1061 (24,03%)

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDOVWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No

Variable Demographic characteristics $JH <47 years t47 years *HQGHU Male Female

All centres

11.5.1 Risk factors for treatment interruptions since 2003

83

$IWHU-XO\SDWLHQWVVWDUWHGDQWLUHWURYLUDOWKHUDS\RIWKHPDOVRKDGWKHLUÂżUVW PHDVXUHPHQWRI&'FHOOFRXQWZLWKLQWKLVSHULRG7KHPRVWIUHTXHQWWKHUDS\UHJLPHQXVHGZDV WKHFRPELQDWLRQ157,ZLWK3,

11.6.1 Regimens of the initial therapy

 ,1,7,$/7+(5$3<$)7(5-8/<


0

50

100

150

200

250

300

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Number of persons who started ART in the respective year

84

1,0

1,2

1,4

1,6

1,8

2,0

Mean 1,5

Âą S.D. Âą 0,8

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Beginning of therapy

Number of the different regimens during the first year of treatment

N= 1396 Number of therapy regimes during the first year of treatment

The following calculations include patients of the current cohort who currently receive therapy that was started between January 1, 1997 and January 1, 2009.

Cohort participants with initial ART

11.6.2 Switching of ART during the rst year of treatment

Number of regimens (mean + 95% CI)

32 40

Tenofovir Zidovudin

9

Nevirapin

17

76

0

8

99

3

5

116

0

23

115

0

19

(N = 143)

Number of patients treated with the drug

21

84

1

26

97

1

14

(N = 124 )

13

31

(N = 102)

11

25

(N = 111)

2

25

2

33

(N = 149)

6

39

(N = 124)

4

11

48

(N = 143 )

Number of patients treated with the drug

(N = 124)

7

0

Saquinavir Ritonavir as Booster

37

Lopinavir/r

22

1

19

9

24

7

34

13

32

3

58

11

21

(N = 124)

26

4

85

4

19

(N = 149)

38

1

35

3

33

(N = 124)

23

(N = 143)

42

1

26

5

2

7

(N = 111)

Fosamprenavir

11

(N = 102)

19

4

(N = 93)

Darunavir

Atazanavir

PI

29

57

9

66

75

1

35

(N = 149)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

28

(N = 93) Efavirenz

Study drug

28

46

11

73

1

28

(N = 124)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

18

Stavudin

78

0

13

(N = 111)

59

86

2

8

(N = 102)

Lamivudin

1

2

(N = 93)

58

NNRTI

Number of patients treated with the drug 1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

Emtricitabin

Didanosin

Abacavir

NRTI

11.6.3 Antiretroviral drugs in the initial therapy

85


(N = 102)

(N = 111)

(N = 124) 1

(N = 143 )

(N = 102)

(N = 111)

(N = 149)

(N = 124) 12

(N = 143 )

Number of patients treated with the drug

(N = 124)

3

2

"Ziagen"

7

1

0

"Trizivir"

1

28

0

"Truvada"

0

35

28

(N = 111)

9

0

"Retrovir"

50

27

(N = 102)

"Kivexa"

46

(N = 93)

1

0

58

27

2

17

15

(N = 124)

1

0

75

34

0

11

21

(N = 149)

0

0

71

14

0

4

8

(N = 124)

25

0

2

90

17

0

1

3

(N = 143)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

(N = 93)

"Epivir"

86

(N = 149)

Number of patients treated with the drug

(N = 124)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

(N = 93)

40

"Atripla"

Number of patients treated with the drug

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

"Combivir"

Raltegravir

Integrase inhibitors

Maraviroc

Entry-/fusion inhibitors

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Efavirenz

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Tenofovir

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Abacavir

0,5

0,5

0,5

1,0

INITIAL

1,0

INITIAL

1,0

INITIAL

1,5

1,5

1,5

2,0

2,0

2,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0

1,0

0,5

1,0

NOT INITIAL

0,5

NOT INITIAL

0,5

NOT INITIAL

1,5

1,5

1,5

 '58*',6&217,18$7,21:,7+,1<($562)67$57,1*$'58*   6,1&(

2,0

2,0

2,0

87


88 1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Lopinavir/r

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

0,5

0,5

0,5

0,5

Fosamprenavir

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Atazanavir

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Nevirapin

1,0

INITIAL

1,0

INITIAL

1,0

INITIAL

1,0

INITIAL

1,5

1,5

1,5

1,5

2,0

2,0

2,0

2,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

0,5

1,0

1,0

NOT INITIAL

0,5

1,0

1,0

NOT INITIAL

0,5

NOT INITIAL

0,5

NOT INITIAL

1,5

1,5

1,5

1,5

2,0

2,0

2,0

2,0

Reasons for discontinuation of drugs in the initial therapy (since 2004, in %) Abacavir

INITIAL THERAPY Treatment failure (i.e. virological, immunological, and/or clinical failure) Virological failure Partial virological failure Immunological failure - CD4 drop Clinical progression Abnormal fat redistribution Concern of cardiovascular disease Dyslipidaemia Cardiovascular disease Hypersensitivity reaction Toxicity, predominantly from abdomen/ GI tract Toxicity - GI tract Toxicity - Liver Toxicity - Pancreas Toxicity, predominantly from nervous system Toxicity, predominantly from kidneys Toxicity, predominantly from endocrine system Diabetes Haematological toxicity (anemiaâ&#x20AC;Ś etc.) Hyperlactataemie/lactic acidosis Death Side effects - any of the above but unspecified Comorbidity Toxicity, not mentioned above Availability of more effective treatment (not specifically failure or side effect related) Simplified treatment available Treatment too complex Drug interaction Structured Treatment Interruption (STI) Structured Treatment Interruption (STI) - at high CD4 Patient's wish/ decision, not specified above Non-compliance Physician's decision, not specified above Pregnancy Study treatment Other causes, not specified Unknown Total

2,4

4,3

0,7

7,5

3,3

1,6

Tenofovir

Emtricitabin/ Lamivudin

0,3

0,3 4,8

9,5 2,4

2,4

Nevirapin

12,0

0,7

Efavirenz

Fosamprenavir

Atazanavir

6,1 3,0

Lopinavir/r

2,2 0,6 0,6

1,1

0,6 0,6

1,1 2,2

0,7 5,2 0,7 0,7

0,9 0,3 0,6 5,4 0,3 0,9

0,7 9,2

0,6 2,8

2,0 0,7 0,7

0,9 3,5 1,3 0,9

16,0 4,0 12,0

3,2 2,9 8,6 1,1

6,1 6,1 6,1

11,6 14,9 1,1

17,2 3,0

2,4

2,4

2,4 4,8 2,4 16,7 11,9 16,7 4,8 4,8 9,5 100%

1,3

10,7 0,3 0,6 3,5 0,6 17,0 10,4 19,9 2,2 0,3 6,3 4,4 100%

1,3

1,6

4,0

11,4 2,9 2,9

11,8

1,1

4,0

0,7 2,6

8,0 100%

6,1

1,1 5,0

2,9

1,1

12,0 4,0 24,0

18,3 14,4 24,8 0,7 5,9 5,3 100%

34,3

2,2 2,2 1,1 16,1 7,5 16,1

2,9 5,7 8,6 11,4

4,3 2,2 100%

5,7 100%

3,0 3,0 3,0 15,2 18,2 15,2

3,0 3,0 100%

9,9 1,1 1,1 2,8 0,6 13,3 11,0 7,2 2,2 0,6 5,0 5,0 100%

89


90

NOT INITIAL THERAPY

Reasons for discontinuation of drugs in not-initial therapy (since 2004, in %) Abacavir

Treatment failure (i.e. virological, immunological, and/or clinical failure) Virological failure Partial virological failure Immunological failure - CD4 drop Clinical progression Abnormal fat redistribution Concern of cardiovascular disease Dyslipidaemia Cardiovascular disease Hypersensitivity reaction Toxicity, predominantly from abdomen/ GI tract Toxicity - GI tract Toxicity - Liver Toxicity - Pancreas Toxicity, predominantly from nervous system Toxicity, predominantly from kidneys Toxicity, predominantly from endocrine system Diabetes Haematological toxicity (anemiaâ&#x20AC;Ś etc.) Hyperlactataemie/lactic acidosis Death Side effects - any of the above but unspecified Comorbidity Toxicity, not mentioned above Availability of more effective treatment (not specifically failure or side effect related) Simplified treatment available Treatment too complex Drug interaction Structured Treatment Interruption (STI) Structured Treatment Interruption (STI) - at high CD4 Patient's wish/ decision, not specified above Non-compliance Physician's decision, not specified above Pregnancy Study treatment Other causes, not specified Unknown Total

3,9

2,0 3,9

8,3

1,3

Efavirenz

Emtricitabin/ Lamivudin

Tenofovir

1,3 1,3

Nevirapin

10,0

Fosamprenavir

Atazanavir

Lopinavir/r

4,2 5,1

2,6 2,6 9,1

3,9 7,8 2,0 3,9

1,3

3,2 30,0

2,9

1,3 9,2

2,9

3,9

2,9 2,9

1,3 3,9 1,3

4,2 20,0

9,1 9,1

8,3

5,6 2,8 8,3

5,1 5,1 5,1

8,3 5,1

4,2

5,6

2,0

2,8

2,0 7,8

10,0

10,0

20,0 2,9 100%

15,8 2,6 100%

10,0 10,0

22,9 11,5 28,6 2,9

21,1 13,2 13,2

19,6 17,6 2,0 2,0 2,0 9,8

1,3

2,0 2,0

3,9

3,9

100%

16,7

9,1

27,3

5,6 2,8 2,8

100%

16,7 16,7 8,3 4,2

9,1 9,1 18,2

25,0 8,3 19,4 2,8 8,3

100%

100%

100%

7,7

10,3 17,9 5,1 15,4 5,1 5,1 2,6 100%

30%

20%

10%

0%

30%

20%

10%

0% 0

40%

0%

10%

20%

30%

40%

50%

2

1

4

2 50%

3 0

4

Fig. 3

1

1

87

N

2 3 4

Fig. 2

Total

HIV-RNA Â&#x2022;400

4 (4,6%) 1153 28 (2,4%)

4

N

1153

2430

2430

Total

0 (0,0%) 2039 66 (3,2%)

HIV-RNA Â&#x2022;400

87

201

4

1

Dosing frequency of drugs other than ARVs

7 (4,0%)

3

0 (0,0%)

HIV-RNA Â&#x2022;400

175

418

3

19

Overall dosing frequency in patients with once daily ARVs

3

Dosing frequency of ARVs

1

Fig. 1

19

N

5 (1,5%) 175

2

HIV-RNA Â&#x2022;400

40%

50%

557 12 (2,2%) 334

1

N

1153 28 (2,4%) 866 38 (4,4%)

HIV-RNA Â&#x2022;400

334

969

2

873

(HIV-RNA Â&#x2022; 400: persons with at least 2.5 months between ART beginning and measurement of viral load)

Overall dosing frequency in patients with once daily ARVs

Dosing frequency of ARVs N

557

670

1

1153

Number of daily drug doses

Frequency of virologic failure related to dosing frequency

0

172

Drugs other than ARVs (Fig. 2)

Drugs other than ARVs in patients with once daily ARVs (Fig. 3)

384

Antiretrovirals (ARVs) (Fig.1) 0

 )5(48(1&<2)'58*'26,1*

91


505 (43,6%)

Any resistance

92

Chi-square-test T-test not significant, p>0,10

167 (14,4%)

IDU versus others

* ** n.s.

434 (37,5%)

102 (8,8%)

396 (34,2%)

337 (29,1%)

339 (29,3%)

MSM versus others

Mode of transmission

High prevalence countries

Nationality

Metropolitan

Area of residence

Women

Gender

AIDS

32 (2,8%)

44,3

Mean age

3-class-resistance

81,7

Mean duration of ART (months)

188,1

95 (8,2%)

>50

Mean CD4 nadir

28 (2,4%)

164 (18,6%)

256 (29,0%)

106 (12,0%)

253 (28,7%)

299 (33,9%)

336 (38,1%)

104 (11,8%)

478 (54,2%)

45,2

98,0

161,8

102 (11,6%)

38 (4,3%)

N= 882

N= 1157

•400

HIV RNA (• 2.5 months between ART+HIV RNA-measurement)

ART • twice daily

ART once daily

HIV drug intake once daily versus twice (• twice) daily (current cohort and current ART)

0,01

<0,01

0,02

<0,01

0,02

<0,01

<0,01

<0,01

0,07 **

<0,01 **

<0,01 **

0,01

0,02

p-value*

1

11

108 152 58

Anxiolytics, hypnotics, sedatives Antidepressants Antipsychotics

(5,0%)

(13,1%)

(9,3%)

(20,1%)

(8,7%)

(3,5%)

(2,3%)

(9,6%)

(1,5%)

(0,9%)

(2,4%)

(13,4%)

(6,2%)

(11,1%)

(7,3%)

women only (ART once daily: N=337, ART • twice daily: N=299) 2 MSM only (ART once daily: N=434, ART • twice daily: N=256)

1

101 232

Current therapy with psychotropic drugs

41

Thyroid hormones Current opiate substitution

27

Bisphosphonates

111

10 17

28

155

72

128

85

N= 1157

Oral antidiabetics Proton pumpe inhibitors

(9,6%)

(1,0%)

(1,9%)

(1,0%)

(12,9%)

(3,8%)

(5,3%)

(1,4%)

(5,3%)

(6,5%)

(1,8%)

(8,9%)

(3,0%)

(0,1%)

(1,5%)

(2,2%)

(3,2%)

ART once daily

Insulin

Fibrate

Statin

Beta blocker

ACE-inhibitors/ angiotensin antagonists

Acetylsalicyl acid

Current medication other than ART

111

Drug overdose (mainly opiates) Opiate dependency

22

Attempted suicide or suicide

11

149

Chronic hepatitis C (currently) HCV-related liver cirrhosis

61 44

Chronic hepatitis B (currently)

6

23

22

6

Osteoporosis

Anal cancer (MSM)

2

Anal intraepithelial neoplasia II, III2

St. p. hysterectomy

1

Invasive cervix cancer1

30

35

Diabetes mellitus Type II CIN II or CIN III or carcinoma in situ

1

17

Stroke Diabetes mellitus Type I

37 25

Myocardial infarction

(12,7%)

(2,0%)

(2,6%)

(3,6%)

(19,3%)

(2,7%)

(9,3%)

(3,5%)

(7,0%)

(6,7%)

(1,0%)

(13,0%)

(5,1%)

(0,3%)

(1,2%)

(2,7%)

(4,5%)

(13,5%)

63

151

93

228

121

55

34

131

19

14

28

125

57

96

69

(7,1%)

(17,1%)

(10,5%)

(25,9%)

(13,7%)

(6,2%)

(3,9%)

(14,9%)

(2,2%)

(1,6%)

(3,2%)

(14,2%)

(6,5%)

(10,9%)

(7,8%)

N= 882

ART • twice daily

112

18

23

32

170

24

82

9

18

20

3

39

45

3

11

24

40

119

N= 882

(11,1%)

N= 1157 128

ART • twice daily

ART once daily

Coronary heart disease

Hypertension

Cumulative incidence/ current diseases

93

0,04

0,01

n.s.

<0,01

<0,01

<0,01

0,05

<0,01

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

p-value*

0,03

0,04

n.s.

<0,01

<0,01

n.s.

<0,01

n.s.

n.s.

n.s.

n.s.

0,02

0,02

n.s.

n.s.

n.s.

n.s.

0,10

p-value*


BENEFITS O ANTIRETROV THERAPY


96

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12. BENEFITS OF ANTIRETROVIRAL THERAPY

Risk factors for mortality after the diagnosis AIDS Linz, Innsbruck Variable Demographic characteristics $JH <42 years Â&#x2022;42 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Hetero +,9FHQWUH Linz Innsbruck Stage of disease &'QDGLU Missing  50 cells/μl 50-199 cells/μl Â&#x2022;200 cells/μl Year of AIDS diagnosis 1986 - 1990 1991 - 1994 1995 - 1997 1998 - 2001 2002 - 2009

Frequencies N= 438 / 831 (52,71%)

(57,44%) (47,63%)

247 / 430 191 / 401

(49,09%) (66,95%) (64,52%) (32,41%)

/ 165 / 351 / 62 / 253

81 235 40 82

(55,46%) (47,06%)

310 / 559 128 / 272

(74,94%) (30,53%)

311 / 415 127 / 416

/ / / /

120 164 70 57 27

/ 29 (100,00%) / 413 (61,02%) / 293 (42,66%) / 96 (33,33%)

29 252 125 32

125 194 149 166

/ 197

(96,00%) (84,54%) (46,98%) (34,34%) (13,71%)

Model 1 (N = 831) Multivariate regression* HR (95% CI) p-value

Univariate regression HR (95% CI) p-value

4,46 3,61 â&#x20AC;&#x201C;5,52 1 1,25 1,02 â&#x20AC;&#x201C;1,54 1 1,71 1,25 â&#x20AC;&#x201C;2,32 2,33 1,81 â&#x20AC;&#x201C;3,00 2,61 1,79 â&#x20AC;&#x201C;3,80 1 1,38 1,15 â&#x20AC;&#x201C;1,67 1

1,95 1,35 â&#x20AC;&#x201C;2,81 1,29 0,88 â&#x20AC;&#x201C;1,91 1 9,93 6,59 2,32 1,63

6,54 4,38 1,48 1,03

â&#x20AC;&#x201C;15,09 â&#x20AC;&#x201C;9,92 â&#x20AC;&#x201C;3,63 â&#x20AC;&#x201C;2,58

<0,001

3,18 2,52 â&#x20AC;&#x201C;4,02 1

<0,001

0,033

<0,001 <0,001 <0,001

1,54 1,08 â&#x20AC;&#x201C;2,19 1,40 1,05 â&#x20AC;&#x201C;1,86 1,38 0,92 â&#x20AC;&#x201C;2,08 1

0,017 0,021 0,116

<0,001

<0,001 0,192

<0,001 <0,001 <0,001 0,039

4,66 4,46 2,08 1,62 1

1

2,95 2,89 1,32 1,01

â&#x20AC;&#x201C;7,36 â&#x20AC;&#x201C;6,88 â&#x20AC;&#x201C;3,29 â&#x20AC;&#x201C;2,58

<0,001 <0,001 0,002 0,044

* adjusted for the variables: gender, HIV centre, CD4 nadir 97


Causes of death

30%

25%

20%

15%

10%

5%

0%

30%

25%

20%

15%

10%

5%

0%

98

35%

35%

In M S O A H N U N A ui cc nk B on on ID th yo to V ci er S xi id no -A -A ca /H de -d ca en ca ID ID rd w C ef tio V t/v n S S us ia in li n de de io in es n le g fin fin fa n di rc td in in se tio g g ea as tu in n/ th es fe m st ct or ro io s k ns e

40%

40%

Causes of death (men)

TOTAL

532

57 85 50 43 7 51 5 49 2 25 7 3 1 3 9 6 5 15 21 36 21 31

Number

%

100,00

10,71 15,98 9,40 8,08 1,32 9,59 0,94 9,21 0,38 4,70 1,32 0,56 0,19 0,56 1,69 1,13 0,94 2,82 3,95 6,77 3,95 5,83

A ID S

H N N M O A S In U ui on B on cc nk th yo to V ci er id xi no -A -A ca /H -d de ca en ca ID ID C rd w ef tio V t/v n S S us ia in li de de n io in es n le g fin fin fa n di rc in in td se tio g g ea as in tu n/ th es fe m st ct or ro io s k ns e

Causes of death (women)

AIDS not s pec ified AIDS defining infec tion AIDS defining m alignanc y Bac terial infec tion, non AIDS defining Other infec tion, non AIDS defining Hepatitis C Hepatitis B Non AIDS defining tum ours Panc reatitis Myocardial infarction or other ischemic heart disease Stroke Gas tro-intes tinal haem orrhage Pulm onary hypertens ion Lung em bolus Chronic obs truc tive lung dis eas e Liver failure (other than HBV, HCV, lactic acidosis) Renal failure Ac c ident/ violent death Suic ide Subs tanc e abus e/ intoxic ation Other c aus es Unkown

12.2.1

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99


Death rate

100

Age (median) Last CD4 cell count (median) Mortality rate per 100 person-years All HIV-associated HBV/HCV-associated Non-AIDS tumours Myocardial infarction Gender Male Female Mode of transmission MSM IDU Heterosexual contacts Age (tertiles) <33 34-45 >45 CD4 nadir <50 CD4 nadir <200 Area of residence Non-metropolitan area Metropolitan city 2,32 1,03 0,30 0,17 0,10 2,48 1,96 1,23 5,57 1,35 4,63 2,57 1,60 5,81 3,86 2,11 2,63

2,83 1,51 0,34 0,11 0,19

3,41 2,26

1,75 5,41 1,25

9,45 4,25 1,22 7,80 6,18

3,33 2,72

Death rates

2001-2004 40,7 206

1997-2000 39,8 145

2,05 2,78

1,87 2,26 2,66 5,07 3,68

1,85 4,54 1,57

2,67 1,62

2,34 1,01 0,19 0,36 0,09

2005-2008 45,8 188

Characteristics of deceased patients and death rates in the cART era

$.+9LHQQD/LQ],QQVEUXFN*UD] VLQFH GHDWKVLQSHUVRQ\HDUV SHUSHUVRQ \HDUV VLQFH

12.2.2

101


102

12.3.1

,WKDVWREHQRWHGWKDWWKHSRLQWSUHYDOHQFHRIKHSDWLWLV&LQDPRXQWHGWRLQWR DQGLQWR

2003

2004

2005

2006

2007 Year of the initial therapy

2008

2009

Patients initiating ART (N) <200 and < 6 months <200 and > 6 months 200-350 and < 6 months 200-350 and > 6 months >350 No CD4 count before ART

Initial therapy 164 43 22 18 21 29 31

159 (26,2%) 37 (13,4%) 27 (11,0%) 13 (12,8%) 32 (17,7%) 21 (18,9%) 29

2003

(23,3%) (17,0%) (8,2%) (20,1%) (13,2%) (18,2%)

2004 183 43 36 13 42 16 33

191 (23,5%) 49 (19,7%) 38 (7,1%) 21 (23,0%) 47 (8,7%) 30 (18,0%) 6

2005

(25,7%) (19,9%) (11,0%) (24,6%) (15,7%) (3,1%)

2006 255 56 55 25 60 47 12

(22,0%) (21,6%) (9,8%) (23,5%) (18,4%) (4,7%)

2007 255 47 46 41 72 40 9

285 (18,4%) 54 (18,0%) 38 (16,1%) 29 (28,2%) 80 (15,7%) 67 (3,5%) 16

2008

(18,9%) (13,3%) (10,2%) (28,1%) (23,5%) (5,6%)

2009

103

1491 329 (22,1%) 262 (17,6%) 160 (10,7%) 354 (23,7%) 250 (16,8%) 136 (9,1%)

Total

CD4 count categories and time elapsed between HIV diagnosis and initiation of ART

75

100

125

150

175

200

225

250

275

300

325

350

375

CD4 cell counts at initiation of ART

 &'&(//&28176

HIV-associated versus hepatitis B/C-associated causes of death (all patients)

Median CD4 cell count before ART


104

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

HETERO

IDU

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

MSM

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

TOTAL

2003

2003

2004

2004

2004

2004

2006

2006

2006

2006

2007

2007

2007

2007

2008

2008

2008

2008

2009

2009

2009

2009

>6 months after HIV diagnosis

Year of ART initiation

2005

2005

2005

2005

<6 months after HIV diagnosis

2003

2003

12.3.2.1 Overview

<HOORZEDUV%HJLQQLQJRIWKHUDS\ZLWKLQPRQWKVDIWHU+,9GLDJQRVLV %OXHEDUV%HJLQQLQJRIWKHUDS\PRUHWKDQPRQWKVDIWHU+,9GLDJQRVLV

CD4 cell counts (nadir and most recent)

12.3.2

CD4 cell count <200 at initiation of ART

105


106

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

Zero >=1

Number of treatment interruptions

0

100

200

300

400

500

600

700

800

900

1000

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

<100 100-200 >200

CD4 count before ART

107

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0

100

200

300

400

500

600

700

800

900

1000

7KHDQDO\VLVLQFOXGHVRQO\SDWLHQWVZKRLQLWLDWHGF$57DIWHU-DQXDU\

12.3.2.2 Most recent CD cell count by duration of therapy

Last CD4 cell count (cells/μl)

Last CD4 cell count (cells/μl)


(44,57%) (41,10%)

1343 / 3013 335 / 815

335 / 815 824 / 1889 519 / 1124

7HQRIRYLUXVHHYHU No ART use Yes No

0,077

<0,001 <0,001 <0,001 <0,001

1,15 0,98 - 1,35 1

- 2,03 - 2,91 - 2,60 - 2,36

0,81 0,68 - 0,98 0,90 0,78 - 1,05 1 0,027 0,173

<0,001

0,69 0,59 - 0,80 1

(41,10%) (43,62%) (46,17%)

<0,001

0,67 0,56 - 0,81

0,916 0,004

0,99 0,83 - 1,19 1,24 1,07 - 1,44 1

(41,69%) (50,96%)

<0,001 <0,001

0,63 0,53 - 0,76 0,60 0,52 - 0,70 1

(41,10%)

(41,10%) (46,65%) (41,34%)

(41,10%) (39,81%) (52,41%)

<0,001 <0,001

0,24 0,20 - 0,30 0,43 0,37 - 0,50 1

1,31 1,96 1,54 1,45

<0,001

0,72 0,61 - 0,86 1

1,63 2,39 2,00 1,85 1

<0,001

1,64 1,43 -1,87 1

0,843 <0,001 0,766

0,059

0,87 0,76 - 1,01 1

0,98 0,85 - 1,14 0,54 0,45 - 0,64 0,96 0,74 - 1,25 1

0,003

0,82 0,72 - 0,93 1

Univariate regression p-value OR (95% CI)

0,69 3,03 1,80 1,92

108

–1,58 –5,37 –3,28 –3,33

-

0,75 0,62 –0,90 1

-

2,14 1,76 –2,60 1

0,52 0,41 –0,65 1

1,05 4,03 2,43 2,53 1

0,12 0,09 –0,15 0,24 0,20 –0,29 1

1,03 0,85 –1,24 0,68 0,53 –0,87 1,05 0,78 –1,42 1

0,002

-

<0,001

<0,001

0,831 <0,001 <0,001 <0,001

<0,001 <0,001

0,782 0,002 0,728

Model 1 (N = 3828) Multivariate regression* p-value OR (95% CI)

* adjusted for the variables: age, gender, area of residence, hepatitis C, Tenofovir use ever

335 / 815 865 / 2075 478 / 938

335 / 815 856 / 1835 487 / 1178

335 / 815 746 / 1874 597 / 1139

(41,10%) (50,54%) (46,13%) (44,18%) (29,98%)

(24,08%) (35,67%) (56,49%)

170 / 706 438 / 1228 1070 / 1894

815 1490 388 498 637

(37,27%) (45,18%)

243 / 652 1435 / 3176

/ / / / /

(48,34%) (36,38%)

1153 / 2385 525 / 1443

335 753 179 220 191

(46,65%) (32,31%) (46,04%) (47,03%)

1269 780 265 1514

/ / / /

(42,87%) (46,22%)

1170 / 2729 508 / 1099

592 252 122 712

(41,42%) (46,24%)

792 / 1912 886 / 1916

Frequencies N= 1678 / 3828 (43,83%)

7KHUDS\VZLWFKHVLQ VW \HDU No ART use Zero •1

No ART use Zero •1

1XPE HURIWKHUDS\UHJLPHQV No ART use <4 •4 7UHDWPHQWLQWHUUXSWLRQV

t 90 60-89 30-59 <30

No ART use

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan Metropolitan Comorbidity +HSDWLWLV& HCV RNA positive HCV RNA negative Stage of disease &'QDGLU  50 cells/μl 50-199 cells/μl t 200 cells/μl ART $57XVHHYHU Yes No 'XUDWLRQRIWUHDWPHQW PRQWKV

Variable Demographic characteristics $JH <42.5 years t 42.5 years *HQGHU Male Female

All centres

12.3.2.3 CD4 cells >500/μl

y

0,77 0,59 –0,99 1

0,66 0,48 –0,90 1

4,78 3,41 –6,69 2,27 1,62 –3,19 2,51 1,86 –3,38 1

0,15 0,11 –0,21 0,28 0,22 –0,35 1

1,10 0,84 –1,44 0,58 0,39 –0,86 1,54 0,99 –2,38 1

0,040

0,008

<0,001 <0,001 <0,001

<0,001 <0,001

0,497 0,006 0,054

Model 1 (N = 1835) Multivariate regression* p-value OR (95% CI)

* adjusted for the variables: age, gender, area of residence, hepatitis C, Tenofovir use ever

7HQRIRYLUXVHHYHU Yes No

<4 •4 7KHUDS\VZLWFKHVLQ VW \HDU Zero •1

Comorbidity +HSDWLWLV& HCV RNA positive HCV RNA negative Stage of disease &'QDGLU  50 cells/μl 50-199 cells/μl t 200 cells/μl ART $57XVHHYHU Yes No 'XUDWLRQRIWUHDWPHQW PRQWKV

t 90 60-89 30-59 <30 1XPE HURIWKHUDS\UHJLPHQV

Variable Demographic characteristics $JH <43 years t 43 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual

All centres

12.3.2.4 CD4 cells >500/μl: patients without treatment interruptions only

109


(6,47%) (6,25%)

(6,26%) (6,53%)

69 / 1066 53 / 848

70 / 1118 52 / 796

20 / 151 (13,25%) 102 / 1763 (5,79%)

19 / 135 (14,07%) 103 / 1779 (5,79%)

Cumulative resistances 157,1157, Yes No

157,1157,3, Yes No

2,67 1,58 â&#x20AC;&#x201C;4,50 1 <0,001

<0,001

0,811

0,96 0,66 â&#x20AC;&#x201C;1,38 1

2,49 1,49 â&#x20AC;&#x201C;4,15 1

0,843

1,04 0,72 â&#x20AC;&#x201C;1,50 1

0,516

2,53 1,39 â&#x20AC;&#x201C;4,60 1

1,96 1,16 â&#x20AC;&#x201C;3,30 1

1

0,52 0,29 â&#x20AC;&#x201C;0,96

3,12 2,08 â&#x20AC;&#x201C;4,68 1

0,56 0,32 â&#x20AC;&#x201C;0,99 1,94 1,19 â&#x20AC;&#x201C;3,16 0,90 0,36 â&#x20AC;&#x201C;2,27 1

0,002

0,011

0,035

<0,001

0,048 0,008 0,822

Model 1 (N = 1914) Multivariate regression* OR (95% CI) p-value

110

* adjusted for the variables: age, gender, area of residence, nationality, treatment switches and treatment interruptions

(6,56%)

100 / 1525

0,85 0,53 â&#x20AC;&#x201C;1,37 1

70 / 655 (10,69%) 52 / 1259 (4,13%)

(5,66%)

<0,001

2,78 1,91 â&#x20AC;&#x201C;4,03 1

(8,47%) (6,14%)

22 / 389

0,217

1,41 0,82 â&#x20AC;&#x201C;2,44 1

0,107

16 / 189 106 / 1725

0,73 0,50 â&#x20AC;&#x201C;1,07 1

0,191 <0,001 0,875

(5,77%) (7,72%)

0,73 0,45 â&#x20AC;&#x201C;1,17 2,48 1,59 â&#x20AC;&#x201C;3,85 0,93 0,39 â&#x20AC;&#x201C;2,23 1

76 / 1318 46 / 596

640 (4,22%) 306 (13,07%) 112 (5,36%) 856 (5,72%)

0,538

1,14 0,76 â&#x20AC;&#x201C;1,70 1

(6,61%) (5,86%)

87 / 1317 35 / 597

/ / / /

0,062

1,42 0,98 â&#x20AC;&#x201C;2,06 1

(7,42%) (5,33%)

71 / 957 51 / 957

27 40 6 49

Univariate regression OR (95% CI) p-value

Frequencies N= 122 / 1914 (6,37%)

After 1.1.1997 1XPEHURIWKHUDS\UHJLPHQV <4 t4 7UHDWPHQWVZLWFKHVLQWKHILUVW\HDU None t1

$57LQLWLDWLRQ Before 1.1.1997

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No ART

Variable Demographic characteristics $JH <45 years t45 years *HQGHU Male Female

All centres

12.3.2.5 Risk factors for a CD4 cell count <200/Îźl on ART

Increase of CD4 cells during ART

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

Zero >=1

Number of therapy interruptions

0

100

200

300

400

500

600

700

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

<100 100-200 >200

CD4 count before ART

111

%HORZRQO\SDWLHQWVZLWKRXWDWUHDWPHQWLQWHUUXSWLRQ VHHEOXHFXUYHVLQDERYHPHQWLRQHGFKDUW DUHVKRZQ EHORZGXHWRWKHLUODVW&'FRXQWEHIRUH$57

0

100

200

300

400

500

600

700

7KHDQDO\VLVLQFOXGHVRQO\SDWLHQWVZKRLQLWLDWHGF$57DIWHU-DQXDU\

12.3.3

Increase of CD4 cells (cells/Îźl) Increase of CD4 cells (cells/Îźl)


112

RIWKHFXUUHQWFRKRUW¶VSDWLHQWV RI KDYHDFXUUHQW+,951$EHORZFRSLHVPO

ART initiation

96 997 998 999 000 001 002 003 004 005 006 007 1 1 2 2 1 19 2 2 2 2 2 2

Strategy A Strategy B

Year of initial antiretroviral therapy 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Lampe F et al. 14,8 20,6 19,8 18,7 18,4 17,7 14,6 27,8 33,2 26,2 24,6 26,9 25,3 21,2 22,6 17,9 20,4 22,3 20,2 AHIVCOS

% of patients without HIV RNA measurement 1 year after the ART initiation

SOHWHIROORZXS 7KHYDOXHVIRUDQGIURP/DPSHHWDODUHVKRZQLQWKHJUDSK SS 

113

&RPSDUHGWRRWKHUFRKRUWV /DPSH)HWDO$UFK,QWHUQ0HG WKHYLURORJLFUHVSRQVH \HDUDIWHU$57LQLWLDWLRQLVVOLJKWO\ZRUVH7KLVLVPRVWO\GXHWRWKHPLVVLQJ+,951$PHDVXUHPHQWV LQFRP-

100 90 80 70 60 50 40 30 20 10 0

Strategy B 1  LQFOXGHVDOOSDWLHQWVRQDQWLUHWURYLUDOWKHUDS\ZKRKDGDWOHDVWRQHPHDVXUHPHQWRI WKHLUYLUDOORDGEHWZHHQPRQWKDQGDIWHUWKHUDS\ZDVVWDUWHG

Strategy A 1  LQFOXGHVDOOSDWLHQWVRQDQWLUHWURYLUDOWKHUDS\SDWLHQWVZKRKDGQRPHDVXUHPHQW RIYLUDOORDG +,951$ EHWZHHQPRQWKDQGDIWHUWKHUDS\ZDVVWDUWHGDUHFODVVL¿HGDVYLURORJLFQRQ UHVSRQGHUV Â&#x2022;FRSLHVPO 

Last HIV RNA in the current cohort

12.4.1

Virologic response 1 year after ART initiation: 1996 to 2007

12.4.2

+,951$ 9,5$//2$'

% HIV RNA Â&#x2022;400 copies/ml


Last HIV RNA of patients on ART

114

0%

0%

Last HIV RNA in copies/ml

10%

10%

Over 9999

20%

20%

10009999

30%

30%

50%

40%

33 34-45 Over 45

40%

50%

Up to 50 51-399 400-999

70%

70%

60%

80%

80%

60%

90%

90%

Agegroup

100%

100%

10009999

Last HIV RNA in copies/ml

Up to 50 51-399 400-999

Over 9999

Male Female

Gender

Current cohort + ART, measurement of viral load at least 75 days after ART initiation

12.4.3.1 Last HIV RNA of patients on ART strati ed by age and gender

HIV RNA <200 copies/ml HIV RNA <400 copies/ml HIV RNA ”50 copies/ml HIV RNA <400 copies/ml, at least 75 days betw. ART initiation + HIV RNA measurement HIV RNA ”50 copies/ml, at least 75 days betw. ART initiation + HIV RNA measurement

3 4 3 2 2 4 8 0 5 9 5 9 6 8 7 7 6 /0 1/0 /0 /0 7/0 /0 /0 7/0 /0 /0 7/0 /0 /0 /0 1/1 /0 1/0 07 01 0 0 07 01 0 0 01 01 01 0 07 07 07 01 0

50

60

70

80

90

100

12.4.3

% of patients

12.4.3.3 Last HIV RNA of patients on ART according to transmission risk

12.4.3.2 Last HIV RNA of patients on ART at different points in time

115


(6,88%) (3,25%)

(3,82%) (3,49%)

13 / 189 56 / 1725

25 / 655 44 / 1259

(8,15%) (3,26%)

(3,04%) (4,40%)

34 / 1118 35 / 796

11 / 135 58 / 1779

(3,32%) (4,19%)

43 / 1294 26 / 620

(7,95%) (3,23%)

(4,03%) (3,07%)

43 / 1066 26 / 848

12 / 151 57 / 1763

(2,31%) (3,93%)

9 / 389 60 / 1525

(6,09%) (3,63%) (2,27%)

(2,88%) (5,20%)

38 / 1318 31 / 596

24 / 394 28 / 772 17 / 748

(2,34%) (7,19%) (3,57%) (3,27%)

640 306 112 856

/ / / /

0,013

0,720

2,20 1,18 â&#x20AC;&#x201C;4,10 1

1,10 0,66 â&#x20AC;&#x201C;1,81 1

0,005

0,119

0,68 0,42 â&#x20AC;&#x201C;1,10 1

2,63 1,35 â&#x20AC;&#x201C;5,14 1

0,340

0,79 0,48 â&#x20AC;&#x201C;1,29 1

0,004

0,261

1,33 0,81 â&#x20AC;&#x201C;2,18 1

2,58 1,35 â&#x20AC;&#x201C;4,93 1

0,130

0,58 0,28 â&#x20AC;&#x201C;1,18 1

0,002 0,123

0,013

0,54 0,33 â&#x20AC;&#x201C;0,88 1

2,79 1,48 â&#x20AC;&#x201C;5,26 1,62 0,88 â&#x20AC;&#x201C;2,98 1

0,290 0,005 0,867

0,71 0,38 â&#x20AC;&#x201C;1,34 2,29 1,29 â&#x20AC;&#x201C;4,07 1,10 0,38 â&#x20AC;&#x201C;3,18 1

3,43 1,59 â&#x20AC;&#x201C;7,40 1

1

2,86 1,46 â&#x20AC;&#x201C;5,62 1,53 0,81 â&#x20AC;&#x201C;2,87

0,86 0,39 â&#x20AC;&#x201C;1,90 2,40 1,25 â&#x20AC;&#x201C;4,62 1,48 0,47 â&#x20AC;&#x201C;4,66 1

0,238

0,74 0,45 â&#x20AC;&#x201C;1,22 1

(3,26%) (4,36%)

43 / 1317 26 / 597

15 22 4 28

2,31 1,28 â&#x20AC;&#x201C;4,17 1

<0,001

2,94 1,70 â&#x20AC;&#x201C;5,06 1

(5,33%) (1,88%)

51 / 957 18 / 957

116

0,002

0,002 0,189

0,718 0,009 0,501

0,005

Model 1 (N = 1914) Multivariate regression* OR (95% CI) p-value

Univariate regression OR (95% CI) p-value

Frequencies N= (3,61%) 69 / 1914

400 copies/ml on ART

* adjusted for the variables: gender, area of residence, nationality, ART initiation, number of therapy regimens, treatment interruptions, treatment switches

Cumulative resistances 157,1157, Yes No 157,1157,3, Yes No

ART $57LQLWLDWLRQ Before 1.1.1997 After 1.1.1997 1XPE HURIWKHUDS\UHJLPHQV <4 t4 7UHDWPHQWLQWHUUXSWLRQV None t1 7UHDWPHQWVZLWFKHVLQWKHILUVW\HDU None t1

<50 copies/Îźl 50-199 copies/Îźl t200 copies/Îźl

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No &'QDGLU

Variable Demographic characteristics $JH <45 years t45 years *HQGHU Male Female

All centres

12.4.4.1 Risk factors for HIV RNA

7KHDQDO\VHVLQFKDSWHULQFOXGHDOOSDWLHQWVLQWKHFXUUHQWFRKRUWZKRKDYHEHHQRQ$57IRUDWOHDVW GD\VEHIRUHWKHPHDVXUHPHQWRIWKHYLUDOORDG

12.4.4 Risk factors for viral replication

(16,40%) (9,80%)

(10,53%) (10,41%) (12,69%) (11,01%) (8,69%)

31 / 189 169 / 1725

69 / 655 131 / 1259 50 / 394 85 / 772 65 / 748

(8,77%) (12,81%)

98 / 1118 102 / 796

24 / 151 176 / 1763 20 / 135 180 / 1779

Cumulative resistances 157,1157, Yes No 157,1157,3, Yes No

1,54 0,94 â&#x20AC;&#x201C;2,55 1

1,70 1,07 â&#x20AC;&#x201C;2,71 1

0,65 0,49 â&#x20AC;&#x201C;0,88 1

1,14 0,84 â&#x20AC;&#x201C;1,53 1

0,088

0,024

0,005

0,399

0,904

0,034 0,130

1,53 1,03 â&#x20AC;&#x201C;2,26 1,30 0,93 â&#x20AC;&#x201C;1,83 1

0,98 0,68 â&#x20AC;&#x201C;1,41 1

0,930

0,005

0,018

1,01 0,75 â&#x20AC;&#x201C;1,38 1

1,81 1,19 â&#x20AC;&#x201C;2,74 1

0,69 0,51 â&#x20AC;&#x201C;0,94 1

0,755 0,011 0,734

0,220

0,82 0,61 â&#x20AC;&#x201C;1,12 1 0,95 0,67 â&#x20AC;&#x201C;1,34 1,65 1,12 â&#x20AC;&#x201C;2,43 1,12 0,59 â&#x20AC;&#x201C;2,12 1

<0,001

2,14 1,57 â&#x20AC;&#x201C;2,92 1

Univariate regression OR (95% CI) p-value

0,59 0,43 â&#x20AC;&#x201C;0,81 1

1,55 1,03 â&#x20AC;&#x201C;2,35 1

1,54 1,02 â&#x20AC;&#x201C;2,33 1,29 0,91 â&#x20AC;&#x201C;1,84 1

1,66 1,03 â&#x20AC;&#x201C;2,65 1

1,11 0,71 â&#x20AC;&#x201C;1,73 1,63 1,07 â&#x20AC;&#x201C;2,50 1,30 0,65 â&#x20AC;&#x201C;2,59 1

1,95 1,39 â&#x20AC;&#x201C;2,72 1

0,001

0,036

0,040 0,159

0,036

0,641 0,024 0,455

<0,001

Model 1 (N = 1914) Multivariate regression* OR (95% CI) p-value

117

* adjusted for the variables: gender, area of residence, ART initiation, resistance against NRTI+NNRTI and treatment interruptions

(14,81%) (10,12%)

(15,89%) (9,98%)

(10,98%) (9,79%)

117 / 1066 83 / 848

(10,28%) (10,49%)

(2,43%) (5,20%)

32 / 1318 31 / 596

40 / 389 160 / 1525

(9,22%) (15,03%) (10,71%) (9,70%)

640 306 112 856

/ / / /

(9,87%) (11,73%)

130 / 1317 70 / 597 59 46 12 83

(13,90%) (7,00%)

133 / 957 67 / 957

Frequencies N= 200 / 1914 (10,45%)

1XPEHURIWKHUDS\UHJLPHQV <4 t4 7UHDWPHQWVZLWFKHVLQWKHILUVW\HDU None t1

Variable Demographic characteristics $JH <45 years t 45 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No &'QDGLU <50 copies/Îźl 50-199 copies/Îźl t 200 copies/Îźl ART $57LQLWLDWLRQ Before 1.1.1997 After 1.1.1997

All centres

12.4.4.2 Risk factors for HIV RNA >50 copies/ml on ART


ISKS OF ROVIRAL HERAPY


120

M41 A62 K65 D67 T69 K70 L74 V75 F77 Y115 F116 Q151 M184 L210 T215 K219

NRTI

L V R N ins R, E V I L F Y M V, I W Y, F Q, E

V90 A98 L100 K101 K103 V106 V108 E138 V179 Y181 Y188 G190 P225 M230

F, T I, V H, C S

M, I

E, P

NNRTI

I G I H, N A, I A D, C, L, A, H L

Reverse transcriptase L10 V11 I13 G16 K20 L24 D30 V32 L33 E34 E35 M36 K43 M46 I47 G48 I50 F53 I54 Q58 D60 I62 L63 I64 H69 A71 G73 T74 L76 V77 V82 N83 I84 I85 N88 L89 L90 I93

F, R, I, V, C I V E R, M, I, T, V I N I I, F, V Q G I, L, V T I, L V, A V V, L L, Y V, M, L, T, S, A E E V P L, M, V K V, I, T, L S, T, C, A P V I A, T, F, S, I, L D V V D, S V M L, M

Protease

The following codons and amino acids have been classified as resistance (IAS):

7KHUHVLVWDQFHPXWDWLRQVKDYHEHHQFODVVL¿HGDFFRUGLQJWRWKH³8SGDWHRIWKH'UXJ5HVLVWDQFH0XWDWLRQVLQ +,9'HFHPEHU´IURPWKH,QWHUQDWLRQDO$,'66RFLHW\86$ KWWSLDVXVDRUJUHVLVWDQFHBPXWDWLRQV PXWDWLRQVB¿JXUHVSGI 

Frequency of NRTI-associated resistance mutations

0 1 0 1

Codon 77 Codon 115 Codon 116 Codon 151

(0,3%)

(0,0%)

(0,3%)

(0,0%)

(0,3%)

(3,8%)

(6,2%)

(4,1%)

14

1

Codon 75

(1,1%)

Codon 219

4

Codon 74

(3,8%)

23

14

Codon 70

(0,0%)

Codon 215

0

Codon 69

(6,5%)

15

24

Codon 67

(0,0%)

Codon 210

0

Codon 65

(0,0%)

37 (10,0%)

0

Codon 62

(5,4%)

Codon 184

20

51 (13,8%)

N = 370

Deceased since 1997, NRTI use

Codon 41

Resistance to NRTI

All centers

50

135

71

195

3

3

5

4

4

23

87

2

123

14

17

122

(2,4%)

(6,4%)

(3,3%)

(9,2%)

(0,1%)

(0,1%)

(0,2%)

(0,2%)

(0,2%)

(1,1%)

(4,1%)

(0,1%)

(5,8%)

(0,7%)

(0,8%)

(5,7%)

292 (13,7%)

N = 2124

Current cohort and NRTI use ever

121

7KHWDEOHVKRZVWKHQXPEHUVRISDWLHQWVZLWK157,DVVRFLDWHGUHVLVWDQFHPXWDWLRQVDPRQJDOOSDWLHQWVZKR KDYHHYHUEHHQWUHDWHGZLWK1XFOHRVLGH5HYHUVH7UDQVFULSWDVH,QKLELWRUV ³157,´ 

13.2.1.1 Overview

13.2.1

³&XPXODWLYHUHVLVWDQFH´LQFOXGHVDQ\PXWDWLRQHYHUIRXQGLQDSDUWLFXODUSDWLHQW

 '(),1,7,212)5(6,67$1&(81'(5$57

Basics: 7KHUDWHRIUHVLVWDQFHGHYHORSPHQWGXULQJDQWLUHWURYLUDOWKHUDS\ ³SHUFHQWZLWKUHVLVWDQFH´ FRUUHVSRQGV WRWKHQXPEHURISDWLHQWVZLWKUHVLVWDQFHPXWDWLRQVLQUHODWLRQWRWKHQXPEHURISDWLHQWVRQ$57 VHHDOVR FKDSWHU  0RVWJHQRW\SLFUHVLVWDQFHWHVWVDUHSHUIRUPHGDWWKH,QVWLWXWHRI9LURORJ\DWWKH0HGLFDO8QLYHUVLW\9LHQQD

 )5(48(1&<2)5(6,67$1&(

13. RISKS OF ANTIRETROVIRAL THERAPY


(0,68%) (0,55%)

(1,33%) (0,25%)

(0,00%) (1,37%) (0,70%) (0,17%)

13 / 1921 6 / 1097

14 / 1050 5 / 1968

0 9 8 2

(0,71%) (0,57%)

(0,89%) (0,18%)

(0,51%) (0,66%)

9 / 1264 10 / 1754

17 / 1900 2 / 1118

3 / 585 16 / 2433

/ 24 / 656 / 1135 / 1203

(0,41%) (0,83%) (0,00%) (0,81%)

/ / / /

(0,67%)

978 599 210 1231

4 5 0 10

6 / 892

0,627

0,031

0,692

1,25 0,51 –3,09 1

5,04 1,16 –21,85 1

0,78 0,23 –2,68 1

0,007 0,067

0,001

5,31 1,91 –14,77 1

8,35 1,80 –38,78 4,26 0,90 –20,12 1

0,665

0,245 0,960 -

1,24 0,47 –3,27 1

0,50 0,16 –1,60 1,03 0,35 –3,02 1

1

0,846

0,91 0,34 –2,40

(0,61%)

5,32 1,18 – 23,99 1

7,55 1,58 –35,99 3,97 0,83 –19,03 1

122

0,030

0,011 0,085

Model 1 (N = 3018) Multivariate regression* OR (95% CI) p-value

* adjusted for the variables: age, gender, mode of transmission, area of residence, Abacavir use ever, ART initiation

Yes No 7HQRIRYLUXVHHYHU Yes No $57LQLWLDWLRQ Before 1.1.1997 After 1.1.1997

$EDFDYLUXVHHYHU

<50 copies/μl 50-199 copies/μl t200 copies/μl ART

Missing

0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHDRIUHVLGHQFH Non-metropolitan Metropolitan Stage of disease $,'6 Yes No &'QDGLU

Female

0,492

0,73 0,29 –1,81 1

Univariate regression OR (95% CI) p-value

(0,53%) (0,73%)

Frequencies N= 19 / 3018 (0,63%)

Variable Demographic characteristics $JH <44 years 8 / 1509 11 / 1509 t44 years *HQGHU Male 13 / 2126

All centres

5HFUXLWPHQWIRUWKLVDQDO\VLVKDVEHHQLQDJUHHPHQWWRHQWU\FULWHULDRI&2+(5(

13.2.1.2 Risk factors for developing a resistance mutation on codon 65 (K65R) of the RT (patients with past or present NRTI use)

Frequency of NNRTI-associated resistance mutations

0 0

Codon 138 Codon 179

1 0

Codon 230

5 Codon 225

Codon 190

1

2

Codon 108

Codon 188

1

Codon 106

18

14

Codon 103

Codon 181

6

0

Codon 100 Codon 101

6

0

(0,0%)

(0,5%)

(2,3%)

(0,5%)

(8,1%)

(0,0%)

(0,0%)

(0,9%)

(0,5%)

(6,3%)

(2,7%)

(0,0%)

(2,7%)

(0,0%)

32 (14,4%)

N = 222

1

5

41

10

58

4

0

16

12

99

19

8

14

5

(0,1%)

(0,4%)

(2,9%)

(0,7%)

(4,1%)

(0,3%)

(0,0%)

(1,1%)

(0,9%)

(7,1%)

(1,4%)

(0,6%)

(1,0%)

(0,4%)

173 (12,3%)

N = 1404

Deceased since Current cohort 1997, NNRTI and NNRTI use use ever

Codon 98

Codon 90

Resistance to NNRTI

All centers

123

7KHWDEOHVKRZVWKHQXPEHUVRI1157,DVVRFLDWHGUHVLVWDQFHPXWDWLRQVDPRQJSDWLHQWVZKRKDYHHYHUEHHQ WUHDWHGZLWK1RQ1XFOHRVLGH5HYHUVH7UDQVFULSWDVH,QKLELWRUV ³1157,´ 

13.2.2


Frequency of PI-associated resistance mutations

124

1

0

0

13

50 (18,2%)

22

1

13

8

7

2

10

Codon 50

Codon 53

Codon 54

Codon 63

Codon 71

Codon 73

Codon 77

Codon 82

Codon 84

Codon 88

Codon 90

(3,6%)

(0,7%)

(2,5%)

(2,9%)

(4,7%)

(0,4%)

(8,0%)

(4,7%)

(0,0%)

(0,0%)

(0,4%)

(0,7%)

(3,6%)

Codon 48

(1,5%)

2

4

Codon 33

(0,7%)

Codon 47

2

Codon 32

(0,7%)

10

2

Codon 30

(0,7%)

Codon 46

2

Codon 24

(5,1%)

36 (13,1%)

14

Codon 20

(6,9%)

Codon 36

19

65 (23,6%)

N = 275

(2,0%)

(0,7%)

(1,1%)

(0,7%)

(4,1%)

(8,5%)

(2,3%)

(0,8%)

(0,1%)

(0,4%)

(0,5%)

(3,8%)

48

19

19

(3,1%)

(1,2%)

(1,2%)

(2,5%)

(8,6%)

132 39

(0,9%)

(6,6%)

14

101

272 (17,7%)

35

13

1

6

7

59

202 (13,2%)

31

10

17

11

63

131

442 (28,8%)

N = 1533

Deceased since Current cohort 1997, PI use and PI use ever

Codon 10

Resistance to PI

All centers

7KHWDEOHVKRZVWKHQXPEHUVRIWKH3,DVVRFLDWHGUHVLVWDQFHPXWDWLRQVDPRQJSDWLHQWVZKRKDYHHYHUEHHQ WUHDWHGZLWK3URWHDVH,QKLELWRUV ³3,´ 

13.2.3

13.2.4

(7,3%)

44 24 30 23

NRTI and NNRTI NNRTI and PI 3-class-resistance

(5,1%)

(6,6%)

(5,3%)

(9,7%)

72 (15,9%)

33

NRTI and PI

PI

NNRTI

52 (11,5%)

NRTI

(1,8%) 82 (18,1%)

8

90 (19,9%)

N = 453

(3,5%)

(8,6%)

136

164

153

(6,4%)

(7,7%)

(7,2%)

252 (11,8%)

482 (22,6%)

184

292 (13,7%)

525 (24,6%)

74

599 (28,1%)

N = 2130

Deceased since Current cohort 1997, and ever ART ever ART

"Any" resistance

Wild type

Resistance test available

All centres

Resistance to single or multiple drug classes

125


126

Resistance test available 169 74 54 35 34 42 23 27 18 21 22 11 19 12 5 4 27 28 143 56 44 106 34 119 4 1 566

Wild type 14 8 6 5 3 6 6 4 5 3 3 2 2 2 1 2 4 11 21 7 5 4 15 1 70

Any resistance 155 66 48 30 31 36 17 23 13 18 19 9 17 10 4 2 27 24 132 35 37 101 30 104 3 1 496

NRTI 125 46 23 13 13 18 9 10 2 3 6 2 5 5 4 1 9 12 90 14 18 75 16 46 2 1 284

NNRTI 73 23 16 4 11 13 6 6 1 9 6 1 4 3 2 5 8 53 17 14 29 5 45 2 178

Resistance to NRTI and PI

PI

139 56 45 27 28 34 17 23 13 18 16 9 17 9 3 2 24 24 119 33 36 88 25 100 2 1 454

109 37 20 10 10 16 9 10 2 3 4 2 5 4 3 1 6 12 78 12 17 63 11 42 1 1 244

NRTI and NNRTI 68 21 15 4 6 11 5 6 1 2 4 1 2 2 2 4 8 50 11 11 25 4 35 2 150

NNRTI and PI 67 19 13 4 10 13 6 6 1 9 3 1 4 2 1 3 8 46 15 14 27 4 41 1 159

3-classresistance 62 18 12 4 5 11 5 6 1 2 2 1 2 1 1 2 8 44 9 11 24 3 31 1 133

Resistance according to demographic characteristics

255 133 114 94 103 94 82 85 101 103 128 132 179 186 250 24 88 151 336 141 240 290 85 649 18 17 2039

13.2.5

All centres Number of patients Year of ART initiation Up to 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Federal state Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing Total

ART initiation after 2000 All centres Number of patients

Resistance test available

Wild type

Any resistance

NRTI

NNRTI

Resistance to NRTI and PI

NRTI and NNRTI

PI

NNRTI and PI

3-classresistance

Year of ART initiation 2001 2002 2003 2004 2005 2006 2007 2008 2009

82 85 101 103 128 132 179 186 250

23 27 18 21 22 11 19 12 5

6 4 5 3 3 2 2 2 1

17 23 13 18 19 9 17 10 4

9 10 2 3 6 2 5 5 4

6 6 1 9 6 1 4 3 2

17 23 13 18 16 9 17 9 3

9 10 2 3 4 2 5 4 3

5 6 1 2 4 1 2 2 2

6 6 1 9 3 1 4 2 1

5 6 1 2 2 1 2 1 1

Residence Central South East West Missing

181 221 528 289 27

36 27 50 44 1

5 3 11 9 0

31 24 39 35 1

15 7 12 11 1

13 5 13 7 -

28 24 37 35 1

13 7 10 11 1

10 3 8 4 -

10 5 11 7 -

8 3 6 4 -

Mode of transmission MSM IDU Others/missing Hetero

428 174 53 591

40 25 3 90

9 4 1 14

31 21 2 76

7 6 1 32

9 7 22

29 20 2 74

6 5 1 30

5 3 17

7 6 20

4 2 15

Gender Male Female

868 378

95 63

13 15

82 48

30 16

26 12

78 47

27 15

18 7

22 11

15 6

Age at time of HIV-test 623 623

127

1246

Total

< 34 years Â&#x2022; 34 years

105 53

18 10

158

87 43

28

26 20

130

23 15

46

84 41

38

23 19

125

14 11

42

20 13

25

11 10

33

21


243

388

Resistance test after ART

Total

5

3

3

mutations

mutations

mutations

mutations

mutations

mutations

mutations

mutations

mutations

mutation

mutations

mutations

mutations

mutations

mutations

mutation

mutations

mutations

mutations

mutations

mutations

mutations

mutations

mutations

2

3

4

5

6

7

8

9

100%

62,6%

N

311

123

188

%

100%

39,5%

60,5%

0

1

2

3

4

5

0

1

2

3

4

5

6

7

8

9

10 mutations

11 mutations

0,3%

1,0%

4,1%

8,5%

6,7%

5,9%

6,7%

3,1%

7,7%

18,6%

9

11

6

3

20

74

2,9%

3,5%

1,9%

1,0%

6,4%

23,8%

0,3%

0,8%

3,9%

7,2%

12,6%

37,9%

4

10

17

92

1,3%

3,2%

5,5%

29,6%

3

2

2

2

1

1

12 mutations

13 mutations

14 mutations

15 mutations

16 mutations

17 mutations

5

9

19

10

12

18

45

55

48

0,3%

0,3%

0,5%

0,5%

0,5%

0,8%

0,8%

0,8%

1,3%

1,3%

2,3%

4,9%

2,6%

3,1%

4,6%

11,6%

14,2%

12,4%

1

1

1

1

2

1

8

5

18

31

31

23

0,3%

0,3%

0,3%

0,3%

0,6%

0,3%

2,6%

1,6%

5,8%

10,0%

10,0%

7,4%

Number of PI associated resistance mutations

1

3

15

28

49

147

Number of NNRTI associated resistance mutations

1

4

16

33

26

23

26

12

30

mutation

1

72

mutations

0

128

%

37,4%

Initial therapy between 1.1.1997 and 31.12.1999

Number of NRTI associated resistance mutations

145

No resistance test after ART

N

Initial therapy before 1.1.1997

1

-

-

3

3

13

19

28

42

50

41

1

5

15

30

149

2

4

2

6

14

36

136

1340

200

1140

N

0,1%

-

-

0,2%

0,2%

1,0%

1,4%

2,1%

3,1%

3,7%

3,1%

0,1%

0,4%

1,1%

2,2%

11,1%

0,1%

0,3%

0,1%

0,4%

1,0%

2,7%

10,1%

100%

14,9%

85,1%

%

Initial therapy after 1.1.2000

09

08

07

2

06

05

03

02

01

00

Year of initial therapy

04

“Any” resistance R = 0,90

99

98

97

96 ” 95

0

10

20

30

40

50

09

2

08

07

06

05

09

2

08

07

06

R = 0,89

04

03

02

01

Year of initial therapy

05

„“Any” y resistance

00

99

98

97

0

10

20

30

40

50

60

09

08

2

07

06

R = 0,61

04

03

02

01

Year of initial therapy

05

3-class-resistance

99

98

09

2

08

07

06

04

03

02

01

00

Year of initial NNRTI therapy

05

Resistance to NNRTI R = 0,64

99

98

97

0

10

20

30

40

50

60

09

08

2

07

04

03

02

01

00

Year of initial NNRTI therapy

05

Resistance to NRTI

06

R = 0,59

99

0

10

20

30

40

50

60

09

08

2

07

04

03

02

01

Year of initial PI therapy

05

Resistance to PI

06

R = 0,88

00

99

98

97

0

10

20

30

40

50

60

09

08

07

06

04

03

02

01

Year of initial PI therapy

05

Resistance to NRTI R = 0,64

2

00

99

13.2.7.4 Development of resistance after initial therapy with 2 NRTI + 1 PI

0

10

20

30

40

50

60

98

98

13.2.7.3 Development of resistance after initial ART with 2 NRTI + 1 NNRTI

0

10

20

30

40

50

60

00

04 03 02 01 00 99 Year of initial therapy

3-class-resistance R = 0,66

13.2.7.2 Any ART regimen and initial ART after January 1, 1997

0

10

20

30

40

50

60

60

Probability of development of resistance

13.2.7.1 Any ART regimen

13.2.7

% Cumulative Resistance

Cumulative resistance related to different time periods of ART initiation

% Cumulative Resistance

% Cumulative Resistance

% Cumulative Resistance

13.2.6

% Cumulative Resistance

% Cumulative Resistance

% Cumulative Resistance

% Cumulative Resistance

97

97

129

96 ” 95

97

98

97


130

10 (5,2%) 8 (9,4%)

N = 85

N = 192

$JH \HDUVPHDQ“6'

)HGHUDOVWDWHV Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Foreign countries Vienna *HQGHU Men Women 0RGHRIWUDQVPLVVLRQ MSM IDU Others/Missing Hetero $,'6 &'QDGLU FHOOV—OPHDQ“6'  &XUUHQW&'FHOOFRXQWV FHOOV—OPHDQ“6'  /DVW+,951$ log10 copies/ml (mean ± S. D.) < 400 copies/ml ” 50 copies/ml 'XUDWLRQRI$57 PRQWKVPHDQ“6'

3-class resistance

3-class resistance

All centres AIDS related deaths after 1996 and ART > 6 months

AIDS related deaths after 1996

13.2.8.1 3-class-resistance in different populations

1,7 ± 1,0 124 (91,2%) 115 (84,6%) 157,5 ± 55,3

(69,9%) (30,1%)

95 41

48 (35,3%) 25 (18,4%) 10 (7,4%) 53 (39,0%) 76 (55,9%) 100,1 ± 89,1 535,9 ± 292,6

(1,5%) (32,4%) (6,6%) (8,1%) (17,6%) (8,1%) (0,7%) (25,0%)

2 44 9 11 24 11 1 34

45,7 ± 9,7

N = 136

(6,4%)

All centres

136

N = 2130

Current cohort and ART use ever

(6,8%) (6,4%)

95 / 1403 41 / 636

(5,3%) (8,0%)

54 / 1020 82 / 1019

/ / / /

(11,3%) (4,4%)

76 / 675 60 / 1364

(7,3%) (5,2%)

102 / 1390 34 / 649

Univariate regress ion p-value OR (95% CI)

0,64 1 1,05 1 1,19 1,31 1,48 1 1,43 1

2,76 1 5,98 3,42 1 0,61 0,60 1

7,40 1

0,45 –0,91

Multivariate regression* p-value OR (95% CI)

0,013

0,72 –1,54

0,785

0,80 –1,79 0,80 –2,14 0,73 –2,99

0,388 0,289 0,276

0,96 –2,14

1,94 –3,92

3,52 –10,14 2,05 –5,71

0,078

<0,001

<0,001 <0,001

-

4,67 2,91 1

0,229 0,398

0,27 –1,36 0,18 –1,98

5,15 –10,63

0,37 0,60

<0,001

7,00 1

2,70 –8,09 1,72 –4,95

<0,001 <0,001

0,15 –0,90 0,17 –2,15

4,70 –10,41

13.2.8.2 Risk factors for the development of 3-class-resistance

(7,0%) (7,6%) (8,5%) (5,9%)

690 331 118 900

48 25 10 53

(12,9%) (7,8%) (2,4%)

410 804 825

53 / 63 / 20 /

(0,0%) (6,6%) (6,4%) (10,3%)

(20,6%) (3,4%)

Patients with 3-class-resistance

Missing

/ 1 / 1892 / 78 / 68

80 / 388 56 / 1651

13.2.8

Model 1 (N = 2039)

All centres Frequencies N= 136 / 2039 (6,7%)

Variable Demographic characteristics $JH <44 years t 44 years *HQGHU Male Fem ale 0RGHRIWUDQVP LVVLRQ MSM IDU Others /mis sing Heterosexual $UHDRIUHVLGHQFH Non-m etropolitan Metropolitan Stage of disease $,'6 Yes No &'QDGLU <50 copies /μl 50-199 copies/μl t 200 copies/μl &XUUHQW+,951$

0 124 5 7

< 400 copies/m l 400-9999 copies /ml • 10000 copies/m l ART $57LQLWLDWLRQ Before 1.1.1997 After 1.1.1997

0,028 0,438

<0,001

131

*adjusted f or the variables: age, gender, mode of transmission, area of residence


3

16

Anal cancer (MSM)2

78

361

3

31

Drug overdose (mainly opiates)

384

105

41

167

Previous and/or current renal failure (N=384)

N = 1262

Currently Tenofovir

Current renal failure (N=105)

132

(15,8%)

(4,3%)

(10,6%)

(1,3%)

(2,0%)

(1,8%)

(14,9%)

(3,2%)

(6,0%)

(1,9%)

(5,6%)

(6,0%)

(1,2%)

(9,9%)

(3,7%)

(0,2%)

(1,2%)

(2,3%)

(3,4%)

(11,4%)

173

25

99

22

26

34

103

16

76

5

30

22

0

35

18

2

12

22

34

75

141

32

N = 632

<0,001

0,007

p-value

Chi-square

(33,5%)

(4,8%)

(19,1%)

(4,3%)

(5,0%)

(6,6%)

(19,9%)

(3,1%)

(14,7%)

(3,0%)

(18,2%)

(13,4%)

(0,0%)

(21,3%)

(3,5%)

(0,4%)

(2,3%)

(4,3%)

(6,6%)

(14,5%)

N= 517

Innsbruck

Currently Abacavir

Percentage related to women [745 in the current cohort (164 in Innsbruck)] Percentage related to MSM [857 in the current cohort (165 in Innsbruck)] Number related to current diseases

Renal failure Ń&#x2C6; stage 3

3

2

1

Renal failure stage 3, 4, 5 (ever)

3

Renal failure stage 3, 4, 5 (current)

257

49

Attempted suicide or suicide

Opiate dependency

44

HCV-related liver cirrhosis

Chronic hepatitis C

Chronic hepatitis B

3

146

48

Anal intraepithelial neoplasia II, III2

Osteoporosis

45

St. p. hysterectomy 1

9

74

CIN II or CIN III or carcinoma in situ1

Invasive cervical cancer1

89

Diabetes mellitus type II

30

Stroke

5

55

Myocardial infarction

Diabetes mellitus type I

83

Coronary heart disease

276

N= 2430

(Comorbidities ever documented)

Hypertension

All centres

Cumulative incidence

2QHDLPRIWKH$XVWULDQ+,9&RKRUW6WXG\LVWRGRFXPHQWFRPRUELGLWLHVDQGDGYHUVHGUXJUHDFWLRQVDVZHOO DVWRLQYHVWLJDWHSRVVLEOHDVVRFLDWLRQVZLWK$57$VDÂżUVWVWHSLPSRUWDQWFRPRUELGLWLHVDUHLOOXVWUDWHG

 &2025%,',7,(6

259 531

Current opiat substitution Current therapy with psychotropic drugs

236

565

120

653

(9,7%)

(23,3%)

(4,9%)

(26,9%)

76

195

61

238

(14,7%)

(37,7%)

(11,8%)

(46,0%)

Innsbruck

(6,4%)

(20,7%)

N= 517

33

107

(16,4%)

(32,1%)

(16,2%)

(10,1%)

(3,9%)

(13,7%)

(0,4%)

(2,1%)

(1,9%)

(18,6%)

(4,6%)

(11,8%)

N= 2430

(5,6%)

(14,2%)

85

166

84

52

20

71

2

11

10

96

24

61

All centres

135

345

(9,2%)

(21,9%)

(10,7%)

(4,2%)

(2,6%)

(11,5%)

(1,8%)

(1,1%)

(2,3%)

(12,2%)

(5,8%)

(10,2%)

(11,8%)

Comparison of â&#x20AC;&#x153;co-medicationsâ&#x20AC;? used in HIV treatment centres run by dermatovenerologists and internal medicine specialists

Antipsychotics

Antidepressants

Bisphosphonates

Proton pump inhibitors

Previous and/or current therapies

Antipsychotics

Antidepressants

224

103

Thyroid hormones

Anxiolytics, hypnotics, sedatives

62

279

Proton pump inhibitors Bisphosphonates

26 43

Oral antidiabetic drugs

56

296

141

249

61

N= 517

(6,9%)

N= 2430 167

Innsbruck

All centres

Insulin

Fibrate

Statin

Beta blocker

ACE inhibitor therapy/ angiotensin antagonist

Acetylsalicylic acid

Current therapies

133

$QRWKHUDLPRIWKH$XVWULDQ+,9&RKRUW6WXG\LVWRGRFXPHQWPHGLFDWLRQIRUFRPRUELGLWLHVDQGDGYHUVHGUXJ UHDFWLRQV$VDÂżUVWVWHSLPSRUWDQWFRPHGLFDWLRQVDUHLOOXVWUDWHG


134

13.3.2

New cases per year

New cases per year

13.3.1

0

5

10

15

20

Gender Male Female Mode of transmission MS M IDU Others/missing Heterosexual Diagnosis before/after ART initiation Before ART initiation After ART initiation Tota l (88, 76% ) (11, 24% ) (41, 57% ) (16, 85% ) (6,74%) (34,83%) (30,34%) (69,66%) (100, 00%)

79 10

37 15 6 31

27 62 89

35 13

15 13 2 18

18 30

48

Gender Male Female

Mode of transmission MS M IDU Others/missing Heterosexual

Diagnosis before/after ART initiation Before ART initiation After ART initiation

Tota l

(100,00%)

(37,50%) (62,50%)

(31, 25% ) (27, 08% ) (4,17%) (37,50%)

(72, 92% ) (27, 08% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Stroke

0

5

10

15

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Myocardial infarction

20

13.3.4

13.3.3

New cases per year

(0,33%) (99,67%) (100, 00%)

Diagnosis before/after ART initiation Before ART initiation 1 After ART initiation 305 Tota l

0

10

20

30

40

50

60

70

(2,54%) (97,46%) (100, 00%)

24 21 12 61

Mode of transmission MS M IDU Others/missing Heterosexual

Diagnosis before/after ART initiation Before ART initiation 3 After ART initiation 115 Tota l

118

(20, 34% ) (17, 80% ) (10,17%) (51,69%)

56 62

Gender Male Female

(47, 46% ) (52, 54% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

306

(30, 07% ) (23, 86% ) (7,84%) (38,24%)

92 73 24 117

Mode of transmission MS M IDU Others/missing Heterosexual

(66, 67% ) (33, 33% )

204 102

Gender Male Female

Lipoaccumulation

0

10

20

30

40

50

60

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Lipoatrophy 70

New cases per year

135


136

13.3.6

13.3.5

0

5

10

15

20

New cases per year

New cases per year

5 6

1 1 2 7

0 11

11

Gender Male Female

Mode of transmission MS M IDU Others/missing Het eros ex ual

Diagnosis before/after ART initiation Before ART initiation After ART initiation

Tota l

Gender Male 121 Female 26 Mode of transmission MS M 46 IDU 15 Others/missing 18 Heterosexual 68 Diagnosis before/after ART initiation Before ART initiation 48 After ART initiation 99 Tota l 147 (32,65%) (67,35%) (100, 00%)

(31, 29% ) (10, 20% ) (12,24%) (46,26%)

(82, 31% ) (17, 69% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

(100, 00%)

(0,00%) (100,00%)

(9,09% ) (9,09% ) (18,18%) (63,64% )

(45,45% ) (54,55% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Diabetes mellitus

0

5

10

15

20

Symptomatic hyperlactatemia y y

250

300

350

13.3.7

3

4

5

6

7

8

9

0

20

40

60

80

100

120

140

160

180

200

220

240

260

0

50

100

150

200

mg/dl mg/dl Percent

N = 1904

N = 240

N = 96

Never ART

N = 632

Ever ART

N = 1732

N = 230

HbA1c

Ever ART

Never ART

LDL-cholesterol

Ever ART

Never ART

Total cholesterol

400

500

600

0

10

20

30

40

50

60

70

80

90

100

N = 240

Never ART

83 / 2430 76 / 20 / 8/ 44 /

Coronary Heart Disease (CHD) CHD and LDL cholesterin measured CHD and LDL>130 Diabetes and HbA1c>8 Diabetes and no recent HbA1c

26 /

LDL>160mg/dl and smoking and no statin

94

94

76

83

34

34 / 348

LDL>160mg/dl and smoking

680 / 2430 348 / 680

188 / 231

LDL>160 and no statin Smoking explored Smoking

231 / 1962

1962 / 2430

N = 1905

Ever ART

LDL>160mg/dl

LDL cholesterol measured

"Quality control"

0

100

200

300

N = 1855

N = 237

Triglycerides

Ever ART

Never ART

HDL-cholesterol

Lipid metabolism abnormalities (current cohort)

mg/dl mg/dl

46,8%

8,5%

26,3%

91,6%

3,4%

76,5%

9,8%

28,0% 51,2%

81,4%

11,8%

80,7%

137


Frequencies N= 105 / 2430 (4,32%)

Univariate regression p-value OR (95% CI)

138

<0,001

0,040 0,088

<0,001

Model 1 (N = 2430) Multivariate regression* p-value OR (95% CI)

Demographic characteristics $JH <0,001 <43 years 23 / 1215 (1,89%) 0,27 0,17 - 0,43 0,29 0,18 –0,46 82 / 1215 (6,75%) 1 1 t 43 years *HQGHU Male 62 / 1685 (3,68%) 0,62 0,42 - 0,93 0,020 Female 43 / 745 (5,77%) 1 0RGHRIWUDQVPLVVLRQ 0,007 MSM 22 / 857 (2,57%) 0,50 0,30 - 0,82 IDU 24 / 384 (6,25%) 1,26 0,76 - 2,07 0,368 0,739 Others/missing 6 / 137 (4,38%) 0,86 0,36 - 2,05 Heterosexual 53 / 1052 (5,04%) 1 %RG\0DVV,QGH[ 18 / 443 (4,06%) Missing 50 / 1055 (4,74%) 0,403 < 24 1,20 0,78 - 1,86 37 / 932 (3,97%) 1 t24 Comorbidity &KURQLFKHSDWLWLV& Yes 21 / 361 (5,82%) 1,46 0,89 - 2,39 0,132 No 84 / 2069 (4,06%) 1 /LYHUFLUUKRVLV 0,018 Yes 6 / 54 (11,11%) 2,87 1,20 - 6,88 No 99 / 2376 (4,17%) 1 Stage of disease $,'6 <0,001 Yes 46 / 701 (6,56%) 1,99 1,34 - 2,95 No 59 / 1729 (3,41%) 1 &'QDGLU <0,001 <50 copies/μl 31 / 426 (7,28%) 3,22 1,91 - 5,44 1,81 1,03 –3,18 50-199 copies/μl 46 / 827 (5,56%) 2,42 1,50 - 3,90 <0,001 1,55 0,94 –2,57 28 / 1177 (2,38%) 1 1 t 200 copies/μl &XUUHQW&'FHOOFRXQW < 350 cells/μl 35 / 546 (6,41%) 1,77 1,17 - 2,69 0,007 70 / 1884 (3,72%) 1 t350 cells/μl ART $57XVHHYHU Yes 105 / 2130 (4,93%) No 0 / 300 (0,00%) &XUUHQW7HQRIRYLUXVH Yes 41 / 1262 (3,25%) 0,58 0,39 - 0,86 0,008 0,44 0,29 –0,66 No 1 64 / 1168 (5,48%) 1 * adjusted for the variables: gender, mode of transmission, Body Mass Index and ART use ever

Variable

All centres

,QFOXGHGDUHDOOSHUVRQVLQWKHFXUUHQWFRKRUW

&XUUHQWFRKRUW

13.3.9

Centre Innsbruck

Risk factors for current renal insuf ciency (stage 3, 4, 5) Model 2 (N = 517) Multivariate regression** OR (95% CI) p-value Model 1 (N = 517) Multivariate regression* OR (95% CI) p-value Univariate regression OR (95% CI) p-value Frequencies N= 76 / 517 (14,70%) Variable

Risk factors for osteoporosis <0,001 0,22 0,11 –0,41 1 <0,001 0,13 –0,46 0,24 1 <0,001 0,10 - 0,33 0,18 1 259 258 14 / 62 /

(5,41%) (24,03%)

0,193 0,43 - 1,18 0,72 1 353 164 47 / 29 /

(13,31%) (17,68%)

0,729 <0,001 0,261 0,46 - 1,72 1,79 - 5,76 0,04 - 2,39 0,89 3,21 0,31 1 165 116 26 210 / / / / 17 34 1 24

(10,30%) (29,31%) (3,85%) (11,43%)

0,039 1,03 - 2,77 1,69 1 256 261 46 / 30 /

(17,97%) (11,49%)

0,020 1,10 - 3,00 1,82 1 262 255 48 / 28 /

(18,32%) (10,98%)

<0,001 1,44 - 4,19 2,46 1 103 414 26 / 50 /

(25,24%) (12,08%)

<0,001 2,44 - 9,41 4,79 1 42 475 17 / 59 /

(40,48%) (12,42%)

0,007 1,24 –3,82 2,18 1 <0,001 2,42 - 6,71 4,03 1 186 331 49 / 27 /

(26,34%) (8,16%)

0,004 0,063 3,25 1,47 –7,19 1,96 0,96 –4,00 1 <0,001 <0,001 2,62 - 11,11 1,77 - 6,42 5,40 3,37 1 86 210 221 23 / 39 / 14 /

(26,74%) (18,57%) (6,33%)

0,009 1,94 - 103,46 14,15 1 (16,82%) (1,41%) 446 71 75 / 1 /

Demographic characteristics $JH <44 years t 44 years *HQGHU Male Female 0RGHRIWUDQVPLVVLRQ MSM IDU Others/missing Heterosexual 6PRNLQJ Yes No %RG\0DVV,QGH[ < 24 t24 Comorbidity &KURQLFKHSDWLWLV& Yes No /LYHUFLUUKRVLV Yes No Stage of disease $,'6 Yes No &'QDGLU <50 copies/μl 50-199 copies/μl t 200 copies/μl ART $57XVHHYHU Yes No

13.3.8

139

** adjusted for the variables: gender, mode of transmission, smoking, chronic hepatitis C, liver cirrhosis and ART use ever * adjusted f or the variables: gender, mode of transmission, smoking, chronic hepatitis C, liver cirrhosis and ART use ever


SUMMARY


142

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Austria antibody Angiotensin-converting enzyme Austrian Agency for Health and Food Safety Austrian HIV-Cohort Study antiretroviral therapy (HIV-therapy) anatomical therapeutic-chemical code Burgenland between Federal Ministry of Health Carinthia Centers for Disease Control cervical intraepithelial neoplasia Commonwealth of Independent States defining European Cenre for Disease Prevention and Control European Centre for the Epidemiological Monitoring of AIDS foreign countries general practitioner hemoglobin A1c hepatitis B hepatitis C high density lipoprotein HIV-Patient-Management-System International Classification of Diseases (WHO) injecting drug users coronary heart disease Lower Austria low density lipoprotein month(s) missing men who have sex with men not available not significant negative Non Nucleoside Reverse Transcriptase Inhibitor Nucleoside Reverse Transcriptase Inhibitor Otto-Wagner-Spital Wien/Otto-Wagner Hospital Vienna protease protease inhibitor republic ribonucleic acid reverse transcriptase Salzburg standard deviation Styria status post Tyrol Upper Austria United Kingdom vertical transmission Vienna Vorarlberg World Health Organization years

15. GLOSSARY

147




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Steering committee:$OH[DQGHU(JOH0DULD*HLW%HUQKDUG+DDV0DQIUHG.DQDWVFKQLJ$UPLQ5LHJHU      $QGUHD6WHXHU5REHUW=DQJHUOH

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16. AUSTRIAN HIV COHORT STUDY GROUP


Health. Nutrition. Safety. Our Concern.

978-3-200-01898-3

17th Report of the Austrian HIV Cohort Study  

The cohort study records the number of the included patients, the number of patients on ART (approximately two thirds of all patients on ART...

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